
Class. 
Book 



COPYRIGHT DEPOSIT 



THE 



BIOGRAPHY 



ephraim Mcdowell, m.d. 



THE FATHER OF OVARIOTOMY." 



BY HIS GRANDDAUGHTER. 



MARY YOUNG RIDENBAUGH. 



TOGETHER WITH 

VALUABLE SCIENTIFIC TREATISES AND ARTICLES 
RELATING TO OVARIOTOMY, 

AND 

EULOGISTIC LETTERS FROM EMINENT MEMBERS OF THE. 
MEDICAL PROFESSION IN EUROPE AND AMERICA. 





NEW YORK: 
CHARLES L. WEBSTER AND COMPANY. 

1890. 



NOTE. 



Occasional repetition of facts recorded in medical works will be 
found in this book. This is owing to the articles containing these 
repetitions having been written by eminent surgeons who were not 
aware of what had already been contributed, and to the fact that a 
portion of the w ;rk had been electrotyped previous to the reception 
of these articles. 



PREFACE. 



Dr. Ephraim McDowell, the subject of this memoir, 
has rested from his earthly labors sixty years, and the 
reader will naturally wonder why such a great length of 
time should have elapsed before his biography had been 
written. Although notices of his wonderful career as a 
surgeon have appeared from time to time, notably one 
written by the late Professor S D. Gross, yet no detailed 
account of his private life has heretofore been given to 
the public. 

At the present time laparotomy is appreciated and 
practised by the entire surgical world, and countless 
thousands are yearly being saved by McDowell's operation, 
ovariotomy. Each year the desire and interest becoming 
greater to know who this man was, and what prompted 
him first to insert the knife into the abdomen, led to a 
determination on the part of several of the most prominent 
surgeons of America to request some one of his de- 
scendants to give to the world all the facts of interest 
that could be gathered relating to the life of this daring 
surgeon. Hence the Authoress of this work, by request, 
has prepared The Biography of Ephraim McDowell, 
M.D., trusting that her labors will be appreciated, 
and the work prove a fitting tribute to the memory of 
one whose entire life was devoted to the cause of suffering 
humanity. 

We are largely indebted to Col. Thomas Marshall Green, 
of Maysville, Kentucky, for a correct and graphic history 
of the antecedents of Dr. McDowell, the persecutions of 

(v) 



vi PREFACE. 

the family, and the flight of its members from their native 
country, together with an account of their success and 
progress after settlement in America. We understand that 
Col. Green has searched diligently the family records to 
obtain everything of interest connected with our subject, 
hence we are secure in quoting from his work, entitled 
Historic Families of Kentucky, in following the ancestral 
line of Dr. Ephraim McDowell. 

Professor Eugene Cordell, of Baltimore, Md., after great 
difficulty and delay, kindly procured a copy of the original 
diploma awarded to Dr. McDowell in the year 1S25. 

We are indebted to Col. J. McD. Alexander, of Virginia, 
for three very interesting letters, one, bearing date of 1 792, 
written to the grandfather of Col. Alexander, and two, in 
1793, .to Ephraim McDowell, while he attended the lectures 
in Edinburgh, Scotland. • 

Dr. Edwin A. Peaslee, of New York City, kindly loaned 
us the use of the fine steel-plate of Dr. McDowell, which 
likeness he had engraved from a daguerrotype furnished 
by the late Mrs. McDowell, forming the frontispiece of 
this work. 

Dr. Coleman Rogers, of Louisville, Ky., also kindly 
presented us with several copies of the "memorial services," 
held in Danville, Ky., at the dedication of the monument 
erected to the memory of Dr. Ephraim McDowell by the 
Kentucky State Medical Society, May 14, 1879. 

As addenda to this life of Dr. McDowell, there will be 
found contributions from some of the leading ovariotomists 
of America and Europe, which, when considered in com- 
bination, will be found possessed of the value of a complete 
text-book on the subject. In these articles is considered 
everything that relates to the matter in its most advanced 
development. Also every incident of interest connected 
with the private life of this remarkable man will be found 
in this work. 

Dr. Nathan Bozeman, of New York City, has given us 
an ably-written article comprising many points of deep 



PREFACE. v ji 

interest to the medical profession. He has prepared his 
article especially for the Biography of Ephraim McDowell, 
M.D., and has spared no pains in its preparation. 

Through the kindness of Dr. John H. Mclntyre, of 
St. Louis, Mo., we have been furnished with a detailed 
description of the operation of ovariotomy, giving the 
reader an opportunity of comparing the present mode of 
operating with that first given to the profession by Dr 
McDowell, in the year 1809. We were desirous of obtain- 
ing an article descriptive of ovariotomy from the able 
writer, Dr. William Goodell, of Philadelphia, Pa.; but, 
on his careful reading of Dr. Mclntyre's paper, Dr. 
Goodell remarked, " The article from Dr. Mclntyre covers 
the entire ground of ovariotomy, and I could not add to 
or take from it one word. I think it admirable." 

To Professor William Tod Helmuth, of New York City, 
we extend our heartfelt thanks for his valuable article, pro- 
nouncing Dr. Ephraim McDowell "the father of ovari- 
otomy" the world over, and for many other kindnesses 
received at his hands. 

Dr. Lewis S. McMurtry, of Kentucky, will please accept 
thanks for sketch of Dr. Ephraim McDowell, by the late 
Dr. John. D. Jackson, of Danville., Ky. 

We are also under obligations to Dr. W. W. Dawson, 
of Cincinnati, O., Prof. D. W. Yandell, of Louisville, 
Ky., and -Prof. Walter Coles, of St. Louis, Mo., for 
valuable articles. 

We are pleased to refer to the late Dr. Washington L. 
Atlee, of Philadelphia, who did so much -toward reestablish- 
ing "ovariotomy." His work entitled Ovarian Tumors, 
is dedicated in part "to the memory of Ephraim McDowell, 
M.D., of Kentucky, the founder of ovariotomy in 1809." 

Drs. J. E. Janvrin, W. Gill Wylie, and Augustin H. 
Goelet, of New York City, and Dr. S. W. Gross, of Phila- 
delphia, Pa., kindly contributed to this work. 

It also gives us pleasure to acknowledge our full appre- 
ciation of all favors extended to us during the preparation 



v iii PREFACE. 

of this work, by Drs. Lewis A. Sayre, George F. Shrady, 
Fordyce Barker, T. Gaillard Thomas, and William M. 
Polk, of New York City; Drs. D. Hayes Agnew, A. R. 
Thomas, and Joseph Price, of Philadelphia, Pa. ; Drs. 
Oliver Wendell Holmes and Henry S. Bigelow, of Boston, 
Mass. ; Drs. Charles T. Parkesand E. C. Dudley, of Chicago, 
111.; Dr. Dudley S. Reynolds, of Louisville, Ky. : Dr. 
Dowling Benjamin, of Camden, N. J. ; and our many 
medical friends in St. Louis, Mo., and elsewhere, who 
are too numerous to individualize. 

Sir T. Spencer Wells and Dr. George Granville Bantock, 
London, England; Professor A. R. Simpson and 
Willoughby Walling, U. S. Consul, Edinburgh, Scotland ; 
Charles William McDowell, Esq., of Otter Holt, Carlow, 
Ireland; M. Starkloff, U. S. Consul, Bremen, Germany; 
and many other eminent surgeons abroad have expressed 
their appreciation of Dr. Ephraim McDowell, and his won- 
derful achievements in surgery, by eulogistic lettrrs and 
valuable articles, some of which will be found in this work. 

Professor James E. Garretson was kind enough to lend 
the value of the literary experience of "John Darby" to 
the Authoress in a reading and revision of her book as it 
went through the press, a favor more than duly appreciated 
and valued. Where remaining faults are noticed, blame 
belongs alone to her. 

"Were we to attempt to enumerate the courtesies and 
kindnesses extended us by the medical profession, a 
detailed account would nil a volume. We can only say 
that their words of encouragement, and full appreciation 
of our labors, have urged us on to the completion of this 
book, and engraven upon our heart a feeling of friendship 
that the blighting hand of time cannot obliterate, and 
it will be a link to the memory of Dr. Ephraim McDowell. 

The several medical journals which have so kindly 
noticed our work in advance of its publication are most 
gratefully remembered by 

The Authoress. 



CONTENTS. 



I. Introduction 

This Work Contains all that has yet been Discovered in the 

Field of Ovariotomy 2 

Circumstances that Prompted McDowell to Perform the First 

Operation 2 

Material for the Work Collected by the Granddaughter of 

McDowell . . . . , 3 

Action Taken in Commemoration of McDowell, by the American 

Medical Association, held at Louisville, Ky., May 4-7, 1875 4 

Earnest Efforts of Drs. John D. Jackson and Lewis A. Sayre, 

to have a Monument Erected to the Memory of McDowell 10 

Dr. McMurtry Subsequently Engaged in Completing this Under- 
taking 11 

Characteristics of Mr. John Bell, Preceptor of McDowell, in 

Edinburgh, Scotland 12 

II. Ancestral Line of Dr. Ephraim McDowell. 

Origin of the Name of McDowell , . . 15 

McDowell of the Race Known as the Scotch-Irish 16 

Arrival of McDowell's Ancestors in Pennsylvania, Sept. 4, 1729 19 

Samuel McDowell, Father of Dr. McDowell, Born Oct. 29, 1735 28 
Dr. Ephraim McDowell, Born in Rockbridge County, Virginia, 

November 11, 1771 . . 33 

III. Early Life of Ephraim McDowell and His 

Educational Advantages. 

Dr. McDowell's Removal to Kentucky when Thirteen Years Old 34 

Description of McDowell at the Age of Manhood ..... 37 
McDowell Attended Lectures at the University of Edinburgh, 

Scotland, in 1793-4 - 38 

Interesting Letters to McDowell from his Father, in 1793 . . 40 

IV. Return from Edinburgh. 

McDowell's Return to Danville, Kentucky, in 1795 .... 51 
Marriage of McDowell in 1802 55 

(ix) 



x COXTEXTS. 

PAGE 

An Incident Connected with McDowell's Study of Biology . . 58 

McDowell's Characteristics 59 

Record of McDowell's Children 60 

Historical Account of Gov. Shelby, of " Kings Mountain " Fame 62 
Indian Legend Connected with the Naming of McDowell's 

Homestead — '< Cambiskenneth " 65 

McDowell as a Slave Owner 66 

Prayer of McDowell Previous to His First Ovariotomy ... 68 

V. The First Case of Ovariotomy. 

First Operation was Performed on Mrs. Crawford, December 

13. l8 °9 7° 

Nature and Hazard of this First Operation ....... 71 

Personal Description of the Heroic Mrs. Crawford 73 

Acknowledgment of McDowell's Daring Skill, by the Medical 

Society of Philadelphia, in 1817 74 

Copy of Diploma Awarded to McDowell in 1825 75 

Operation on James K. Polk by McDowell, with Letter of Appre- 
ciation from Patient jj 

McDowell's Crossing the Ocean on Three Occasions to do the 

Caesarean Section 78 

One Instance of McDowell's Charity in Undertaking a Perilous 
Tourney of Over One Hundred Miles to Gratuitously 

Perform Ovariotomy ......... o .. ; 83 

VI. Persecutions. 

'•'A Great Theory Never Accepted without Opposition" ... 85 

Dr. Hunn's Misrepresentations and Scandalous Allegations . . 86 

Negroes Regarding McDowell with Suspicion and Horror . . 88 

McDowell made a Target by an Envious Pretender — Mr. Lizars 89 

Interesting Article Contributed by Prof. William Tod Helmuth 90 

VII. Death of Dr. Ephraim McDowell. 

Dr. McDowell Passed from His Earthly Labors, June 20, 1S30 ico 

Dr. McDowell's Virtues, and His Abiding Faith in His Creator 102 

Pecuniary Circumstances of the Deceased Surgeon 104 

Desolation and Death of Mrs. Dr. McDowell 105 

Removal of Dr. and Mrs. McDowell's Remains to Danville, 

Ky., in 1879 106 

VIII. Criticisms and Comments. 

Dr. Ezra Michener's Sarcastic Allusions to McDowell .... 108 

Dr. Washington L. Atlee's Early Persecutions 109 



CONTENTS. x i 

PAGE 

Mr. Lawson Tait's Comments 115 

Reply to Mr. Tait by the Authoress 118 

Statistics and Remarks Regarding Ovariotomy in Various 

Countries, by Dr. E. Randolph Peaslee 120 

Tables of Completed Ovariotomy in the United States, Great 

Britain, France, and Germany up to 1872 136 

IX. Comments upon Ovariotomy. 

Dr. Washington L. Atlee's " Diagnosis of Ovarian Tumors " . 142 
Dr. Peaslee publishes, in 1872, Facts establishing Dr. McDowell's 

Priority as an Ovariotomist 152 

Prof. \V. Gill Wylie's Report on no Cases of Laparotomy . . 154 

Dr. Augustin H. Goelet in Favor of Electricity 155 

X. Joseph Nashe McDowell, M.D. 

The "McDowell Medical College," in St. Louis, Mo., Founded 

by Dr. J. N. McDowell 158 

The Doctor's Peculiarities in Treating Patients 160 

His Emaciated Form Suggests the Pseudonym of "Sawbones" 162 
Cause of Alienation Between Dr. J. N. McDowell and His 

Uncle, Dr. Ephraim McDowell 163 

Meeting of the Authoress with Dr. J. N. McDowell, at a Dread- 
ful Collision Between Two Trains of Union and Confeder- 
ate Wounded Soldiers and Refugees 166 

Wreck of the McDowell Medical College, and its Re=toration 167 
The Doctor's Crank Idea in Setting Apart and Designating One 

Room as " Hell " 169 

Eccentricities of the Doctor 171 

Death of Dr. Joseph Nashe McDowell, October 3, 1868 . . . 176 
Father De Smit's Conversion of Dr. J. N. McDowell to the 

Roman Catholic Faith 178 

The Doctor's Idiosyncrasy Regarding the Burial of His Infant 

Children 178 

Biographical Sketch of the Late Col. Basil Duke (a Relative of 
Joseph Nashe McDowell, M.D.) States the Fact that a Few 
Years Ago Europe Erected a Suitable National Monument 
to the Memory of Dr. Ephraim McDowell 180 

XI. Biographical Sketch of Ephraim McDowell, 
M.D., by the Late Dr. John D. Jackson. 

Dr. Jackson's Great Veneration for McDowell 181 

McDowell Performed Every Surgical Operation then Known to 

Science 182 



x ii CONTEXTS. 



Dr. James Johnson Asks Pardon of God and of Dr. Ephraim 

McDowell, for His Uncharitableness Toward the Doctor . 183 

McDowell's Reply to His Critics, and Ardent Wish that the 

Operation of Laparotomy may not be Abused 184 

185 
191 

193 
195 
197 



Liberality of Mr. Overton, of Tennessee 

McDowell Remarkable for His Strength and Agility . . 

McDowell's Method of Treating Fever 

McDowell's Coolness and Dexterity as an Operator . . 
— — All Women Should Bless the Name of Ephraim McDowe 

United States of America Should Erect a Fitting Monument to 

His Memory 198 

Bronze Statue of Dr. Ephraim McDowell Should be Erected 
Solely from Voluntary Contributions made by those Women 
who Owe their Lives to Ovariotomy 199 

XII. Sketch by W. W. Dawson, M.D. 

Address Delivered Before the " American Medical Association/' 

at Newport, R. I., in 1889, by W. W. Dawson, M.D. . . 201 
Statistics of the First Medical Schools Formed in America . . 202 

XIII. Description of One of the Methods of Per- 

forming Ovariotomy, by Dr. John H. 
McIntyre, of St. Louis, Mo. 

" McDowell Cut Away the Abdominal Barriers, and the Sur- 
geons Walked In and Reaped the Harvest of his Daring 
Surgical Adventure " 210 

Sir James Paget stated— "This Operation is One of the Greatest 

Achievements of Surgery '' 213 

Lord Selborne regarded Ovariotomy as " One of the Most 

Splendid Triumphs of Modern Surgical Art '' 215 

Dr. John H. Mclntyre's Method of Performing the Operation 216 

XIV. McDowell's Operation of Ovariotomy by the 

Long Incision during the First Thirty- 
three Years of its Employment. With Com- 
ments. By Nathan Bozeman, M.D., of New 
York City. 

in tr od uc tion. 

McDowell's Operation of Ovariotomy. His Cases and Success. 

Their Influence on the World . . = 228 



CONTENTS. x iii 

PAGE 

Xames Made to Precede McDowell's in Tables of Statistics . . 231 
McDowell's Name Placed by Mr. Benjamin Phillips, of England, 

in his Statistics at the Head of the List of Operators . . 232 

McDowell's Claims Accorded by Prof. Samuel D. Gross . . . 233 

Acknowledged as the Founder of Ovariotomy by Dr. Atlee . . 234 

Statistics by Surgeons at Large Regarding McDowell's Priority 235 

The Long Incision 236 

Le Dran's Observations and Experiences, 1736 to 1746 . . . 238 

Delaporte's Operation 239 

Incisionism and the Drainage Tube 240 

L'Aumonier's Operation, 1782 242 

McDowell and Incisionism . 243 

The Long Incision of McDowell 244 

McDowell's Advance on Incisionism 245 

Error of McDowell's Followers 245 

Failure of the Short Incision 247 

Long and Short Incision Compared 248 

Typical Case Showing Advantages of the Long Incision . . . 249 
How this Operation has been Studied and its Advantages 

Brought Out . s 253 

Immediate Followers of McDowell in the United States . . . 253 

Attention Directed to Growth of Interest ........ 256 

SECT. ON I.- OVARIOTOMY IN THE UNITED STATES. 

Account of Three Cases of Extirpation of Diseased Ovaries by 

Dr. McDowell 259 

Dr. Ezra Michener of Philadelphia Criticises the Operation . . 262 

Dr. Henderson as a Defender of McDowell 264 

Observations on Diseased Ovaria by Dr. McDowell .... 267 

Comments by Writer 273 

Thirteen Performances of the Operation by McDowell . . . 277 

Ovarian Operation by Dr. Nathan Smith of Connecticut . . . 284 
Comments on Smith's Operation by Drs. Nathan R. Smith and 

E. R. Peaslee 286 

Comments by Writer 288 

Alban G. Smith's Case of Ovariotomy 294 

R. D. Mussy's Case of Ovariotomy 298 

Comments by Writer 300 

David L. Rogers's Case of Ovariotomy 300 

Comments by Writer 302 

Distinctions in Ovarian Tumors by Dr. J. C. Warren .... 303 

Comments by Writer 304 

Dr. Bellinger's Case of Ovarian Tumor Complicated with 

Hydrops Uteri 305 

Conclusion of Comments by Writer, and Summary . . . . 305 



XIV 



CONTENTS. 



SECTION II- O VARIO TO MY IN FRANCE. 

History in France of Tapping and Incisionism 307 

Lisfranc's Clinical Report 308 

Delaporte and Extirpation of the Ovary 310 

Old Procedures Practised in France ., 311 

Le Dran and Morand, Memoires Royal Academy 312 

Encysted Dropsy Treated by Lc Dran 313 

Nuck's Case of Abdominal Tumor 314 

Le Dran's Second Case 316 

Cases Treated by M. De La Cbaud and Montau'.ieu .... 318 

First Proposal of Extirpation of a Dropsical Ovary .... 320 

Comments on Case by M. Morand 321 

Extirpation of Ovary Suggested by Delaporte, 1750 .... 323 

Neglect of Subject from 1807 to 1837 329 

Establishment of Drainage by M. Recamier . 331 

No Operation for Extirpation of Ovary Performed in France up 

to 1839 331 

Comments by Writer 333 

Theden's Scheme for Extirpating Ovary ........ 342 

L'Aumonier and his Operation 343 

Conclusion of Comments by Writer 350 

SECTION III — OVARIOTOMY IN GERMANY. 

Dzondi, of Halle, Association of his Name with Ovariotomy . 351 

Results obtained by Chrysmar, Dieffenbach and Others . . . 353 
Dr. Chrysmar the First to Perform McDowell's Operation in 

Germany 354 

Three Cases of Ovariotomy by Chrysmar 355 

Dr. Ehrhartstein. Synopsis of a Case 357 

On the Puncture and Extirpation of Tumified Ovaiies . . . 358 

Comments on Case by Dr. Dolhoff 361 

Summary of Cases in Germany 365 

Comments by Writer 305 

SECTION IV.— OVARIOTOMY IN GREA T BRITAIN. 

Antiquity of the Tapping Operation 377 

Encysted Dropsy Recognized 378 

Houston and his Original Procedure by Incision 379 

Incisionism and Incisionists , . 379 

Claims Affecting McDowell 380 

Atlee's Table of Ovariotomists, 1701 to 1851 3S1 

Dr. Houston's Case of Dropsy of the Left Ovary 381 

Influence of Houston on the Profession in France 386 



CONTENTS. X v 



PAGE 



Hunter's Criticism regarding Origin of Dropsical Ovaries . . 387 

Credit due Dr. Hunter •• . 390 

Influence of the Incisionists on Hunter 392 

Lizars's Observations on Extirpation of the Ovaries .... 395 

False Diagnosis and Unjustifiable Operation 399 

Instruction of Lizars by McDowell*s Manuscript 401 

Report of Three Cases by Mr. Lizars . 401 

Criticism of Dr. McDowell by Dr. Johnson 403 

Augustus Bozzi(Dr. A. B. Granville). His Operations in London 408 

Mr. R. C. King, of Suffolk. His Operations 410 

Mr. Teaffreson and his Views 413 

Mr. W. J. West, of Tunbridge Wells, and his Cases .... 418 

Hargrave's Case 421 

Guy's Hospital Case 421 

Mr. Crisp's Case 423 

Mr. Benjamin Phillips's Case 423 

Summary of Cases and Results in Great Britain ..... 425 

Comments of Writer on British Ovariotomy and Ovariotomists 425 
General Summary of Cases and Results in the United States and 

Europe 444 



XV. Eulogistic Letters, etc. 

Letter from Sir T. Spencer Wells, London, England, Dated July 
2, 1887, Enclosing Remarks Relating to Ephraim McDowell, 
M.D., made at the '• College of Surgeons " in 1878 . . . 445 

The Remarks of Sir T. Spencer Wells 446 

Letter from Dr. George Granville Bantock, London, England, 
Expressing the Wish that a Grand Success will Crown the 
Efforts of the Authoress . 449 

Letter from Prof. A. R. Simpson, Edinburgh, Scotland, Dated 
October 20, 1887, to Dr. Willoughby Walling, United States 
Consul 450 

Letter from Dr. Willoughby Walling, Edinburgh, Scotland, 
Dated October 20, 1887, to the Authoress, Enclosing Letter 
to Him from Prof. A. R. Simpson 451 

Letter from Prof. A. R. Simpson, Dated December 6, 1887, En- 
closing Copy of the Lecture Delivered by Him at the Uni- 
versity of Edinburgh, Scotland, October 19, 1887 .... 452 

The Lecture Delivered by Prof. Alexander Russell Simpson . . 452 

Tribute to Dr. Ephraim McDowell by Prof. D. W. Yandell, 
Delivered at a Complimentary Dinner Given to Prof. 
Samuel D. Gross, at Philadelphia, Pa 460' 

Letter from Prof. Walter Coles, St. Louis, Mo., Dated May, 

1889, Eulogizing Dr. Ephraim McDowell 463 



xvi CONTENTS. 

XVI. Memorial Services at the Unveiling of the 
McDowell Monument, at Danville, Ky., May 
14, 1879. 

PAGE 

Preface, by the Committee of Publication 467 

Letter from Dr. Coleman Rogers, Louisville, Ky., Chairman 

Committee of Publication 471 

Letter from Dr. L. S. McMurtry, Danville, Ky., Chairman 

McDowell Monument Committee 471 

Dedicatory Address, by Professor Samuel D. Gross, M.D. 472 

Address of Professor Lewis A. Sayre, New York Chy .... 537 

Letter from Dr. J. M. Toner, Washington, D. C 541 

Letter from Dr. Theophilus Parvin, Indianapolis, Ind. . . . 544 

Letter from Dr. T. G. Richardson, New Orleans, La 545 

Letter from Sir. T. Spencer Wells, London, England .... 547 

Letter from Dr. Oliver Wendell Holmes, Boston, Mass. . . . 543 

Letter from Dr. T. Gaillard Thomas, New York City .... 551 
Presentation Address — Remarks by Prof. Richard O. Cowling, 

M.D., of Louisville, Ky., in Presenting the Door-knocker of 

Dr. McDowell to Professor Samuel D. Gross, M.D. . . . 553 

Reply cf Dr. Gross 557 



CHAPTER I. 



INTRODUCTION. 



In the work now about to be put before the 
public, it is proposed to give a history of the 
late Dr. Ephraim McDowell, with a sketch of 
his antecedents, a description of his surround- 
ings, a review of the times in which he lived, 
together with a treatise on ovariotomy, com- 
paring the present mode of operating with 
that of eighty years ago, besides some interest- 
ing accounts of results that have sprung from 
the daring experiments of the frontier doctor, 
who, without anaesthetics, with inadequate in- 
struments and unskilled assistants, conferred 
upon woman the greatest boon that surgery 
has ever given the sex. 

The work also contains letters and papers 
from some of the foremost American and Eng- 
lish surgeons testifying to the high place that 
Dr. McDowell holds in the history of surgery, 
and making clear his right to be called "The 
Father of Ovariotomy." These papers are not 



2 INTRODUCTION. 

only eulogistic, but coming from the highest 
sources are equally instructive. 

The work contains all that has yet been dis- 
covered in the field of ovariotomy, besides giving 
the general reader an interesting narrative of 
the life and times of one of the most remarka- 
ble men of early Kentucky. The causes which 
have led to a great and unexpected scientific 
achievement, the conditions under which it was 
performed, and the character of the man to 
whom it is due, must always be of interest 
to those concerned in the world's progress. 
Therefore it will be of peculiar interest to 
note the circumstances under which McDowell 
performed his first ovarian operation, as well 
as to discover just what manner of man was 
he whom his contemporaries denounced as 
little better than a murderer, and who yet had 
the temerity to insert the knife into the abdo- 
men of a woman, and to do this again and 
again. 

In order that his surroundings may be fully 
depicted, the author has carefully gathered all 
that has been written about him, and noted 
the conditions of society at this early date in 
Kentucky. 

Dr. McDowell married the daughter of Isaac 



INTR OD UC TION. 3 

Shelby, Kentucky's first Governor, and this 
circumstance enables the writer to bring before 
her reader some most interesting reminiscences 
of the early politics of the State, in which 
McDowell played no part, but which have a 
direct interest as showing the state of the 
times. 

The material for the work has been collected 
by a granddaughter of Dr. McDowell (Mrs. 
Ridenbaugh), who, being a descendant of these 
two eminent men, Ephraim McDowell and Isaac 
Shelby, unusual facilities have been offered her 
for making the required investigations. She 
has received the assistance of several eminent 
physicians and surgeons, the members of the 
fraternity displaying warm interest and zeal in 
aiding the production of a fitting memento of 
her grandfather. 

The great surgeon was born in Virginia, but 
was brought by his parents to Kentucky when 
Daniel Boone was still fighting the Indians on 
"the dark and bloody ground" of Kentucky, 
which State was literally a wilderness. Long 
afterward it was admitted to the Union. 

It is not to be supposed that it was in the 
wilds of the frontier that young McDowell 
learned to use the knife so skilfully and boldly. 



4 INTRODUCTION. 

Perhaps it was the pioneer spirit which gave 
him courage to make the experiment ; at a 
period, too, when it was difficult to obtain pro- 
fessional consultation, as then we had not en- 
tered the progressive age, the age of won 
drously rapid development, when efforts to 
girdle this microcosm of ours have been suc- 
cessfully accomplished in sixty-two days and six 
hours. 

Dr. McDowell planned and put into execu- 
tion an operation which, though successful, 
brought him, at the hands of the medical pro- 
fession, vituperation and violent opposition, 
posing him before the world as a heartless 
"woman-butcher." Quoting the words of the 
late Dr. W. L. Atlee, "he had little else than 
the book of nature before him, and the con- 
sciousness of right to sustain him." 

The twenty-sixth annual meeting of the 
American Medical Association was held in 
Public Library Hall, Louisville, Kentucky, on 
May 4, 5,6, and 7, 1875. The Association was 
called to order by Dr. Edward Richardson, of 
Louisville, chairman of the committee of ar- 
rangements. 

The meeting was honored by the presence 
of many distinguished gentlemen from distant 



INTR OB UCTION. 5 

regions ; surgeons and physicians met for the 
advancement of medical science and for the 
promotion of high interests both as regards the 
profession and the community. 

Dr. Richardson, in his address of welcome 
on this interesting occasion, made the following 
allusion to some of Kentucky's noblest sur- 
geons who have done honor to the profession : 

"It is to us, Mr. President, assembled as we 
are, in the presence of so many eminent mem- 
bers of the profession, a source of congratula- 
tion that our State is not unknown to medical 
annals, and that she may justly assert the dis- 
tinction of being- the first to introduce into sue- 
cessful practice several of the most important 
and beneficent operations of surgery, perform- 
ances now widely known and appreciated, both 
here and in foreign lands. 

''The names of McDowell, of Bradshear, of 
Briggs, of Dudley, have, with those of others, 
been placed high upon the roll of fame as 
original and independent thinkers and workers 
— men who have deserved well of their com- 
peers in the healing art ; and it is, Mr. Presi- 
dent, a grateful, if it be even but a fond im- 
agination, that their revered shades are now 
present with us, to do honor to this occasion 



6 INTR OD UCTION. 

and to enlarge our welcome by the addition 
of their own. Nor would it be improper, Mr. 
President, if our State should institute also a 
claim, or a part at least, to more than one of 
the distinguished gentlemen who are now en- 
rolled as Eastern members of the American 
Medical Association. 

"It is probable, however, Mr. President, that 
the larger portion of the membership of the 
Association have now, for the first time, visited 
our State. Allow me to say to these that it is 
for the stranger that Kentucky ever accords a 
peculiar welcome, and that it is in 'her old Ken- 
tucky home' that she loves to dispense the 
grateful tribute due to the eminent in science 
and to public benefactors of society who honor 
her with their presence." 

After various papers had been read, the res- 
olutions relating to the business of the Asso- 
ciation were then taken up and acted upon. 
Dr. J. Marion Sims, of New York, read the 
report of the committee on the "McDowell 
Memorial Fund," which, on motion, was re- 
ceived, and the resolutions were unanimously 
adopted. These resolutions were as follows : 

Resolved, Whereas, it is universally acknowl- 
edged that the late Ephraim McDowell, of 



INTRODUCTION. . j 

Danville, Kentucky, was the originator of the 
operation of Ovariotomy ; and 

Whereas, We believe that proper measures 
should be instituted to commemorate this great 
achievement, and do appropriate honor to its 
author ; therefore 

Resolved, That this Association recommends 
to each of its members, and to the profession 
generally, that contributions be made annually 
of such sums as may be thought proper until 
the amount of ten thousand dollars shall be 
accumulated, which money shall be known as 
the "McDowell Memorial Fund," the interest 
of it to be devoted to payment of prizes for the 
best essays relating to the diseases and surgery 
of the ovaries. 

Resolved, That this fund shall be invested by 
trustees to be appointed by the Association, 
and be subject to such regulations as it may 
devise. 

Resolved, That this Association shall elect a 
board of three trustees, whose duty it shall be 
to carry out the object of these resolutions, 
and whose term of office shall continue five 
years. 

Resolved, That this Association will leave to 
the State of Kentucky the grateful privilege of 



8 INTR OD UC TION. 

providing a local memorial to the memory of 
Dr. Ephraim McDowell. 

Respectfully submitted, 

J. Marion Sims, New York. 

Washington L. Atlee, Penna. 

W. H. Byford : Illinois. 

J. M. Keller, Kentucky. 

On motion of Dr. J. Morris, of Maryland, the 
following gentlemen were appointed trustees 
of the McDowell Memorial Fund : Drs. Wash- 
ington L. Atlee, Pennsylvania; W. H. Byford, 
Illinois ; J. M. Keller and John D. Jackson, 
Kentucky ; and J. Marion Sims, New York. 

The following relates to the first series of 
essays pertaining to the McDowell Fund, and 
is to have its relevancy understood later. 

Dr. L. P. Yandell, chairman of Committee on 
Prize Essays, reported as follows : 

The Committee on Prize Essays beg leave 
to report that they have received a number of 
essays, carefully written and marked by various 
degrees of merit. But after as careful an ex- 
amination of them as the Committee have had 
time to make, they are not prepared to recom- 
mend any as worthy of the prize offered by 
the Association. One of the papers submitted 



INTR OD UC TION. g 

to your Committee is a work of vast dimen- 
sions. It makes four volumes, and an aggre- 
gate of more than twelve hundred pages. 

The Committee have found it utterly imprac- 
ticable in the time at their disposal to look 
through this elaborate paper. It treats of 
" Excision of the Larger Joints," and strikes the 
Committee as worthy of a careful examination. 
They would, therefore, recommend that it be 
submitted to a committee of experts, to be 
reported upon at the next meeting of the 
Association. Respectfully submitted, 

L. P. Yandell, 

Chairman. 

The report was received and the recommen- 
dation adopted. Drs. S. Ashhurst, S. D. 
Gross, and D. Hayes Agnew, of Pennsylva- 
nia, were appointed as the committee. 

Committee on Prize Essays : Drs. Samuel 
D. Gross, F. G. Smith, Alfred Stille, Ellerslie 
Wallace, and H. C. Wood, of Pennsylvania. 

Dr. John D. Jackson, of Danville, Kentucky, 
as we see, was afterward appointed as one of 
the trustees of the McDowell Memorial Fund. 
He attended the meeting - of the American 
Medical Association at Detroit, Michigan, in 
1874, and upon that occasion he tried to im- 



I o INTR OD UCTION. 

press upon the members of the Association the 
duty of the medical profession generally to 
erect a monument, as a fitting tribute of respect 
to the illustrious subject of our memoir, and 
giving to him the honor to which he is justly 
entitled, as the originator of Ovariotomy. 

As early as 1872, Dr. Jackson consulted with 
the distinguished Dr. Lewis A. Sayre, of New 
York, as to the propriety of erecting a monu- 
ment to the memory of the late Dr. Ephraim 
McDowell. Dr. Sayre urged him to push the 
matter, and said " undoubtedly a monument 
worthy so great a man should be erected, and 
that he (Dr. Sayre) then and there would 
contribute liberally to such a worthy cause." 

After several conversations with him upon 
the subject, Dr. Jackson returned to Kentucky 
fully determined in his own mind to leave no 
effort unmade to put into execution, at no dis- 
tant day, the result of his plans and of conver- 
sations with Dr. Sayre ; for after having met 
him he was still more strongly impressed that 
a monument should be erected. 

About the time that Dr. Jackson thought 
all the necessary arrangements perfected to 
carry out his purpose (and really the cherished 
object of his heart), he was stricken with a 



INTR OD UCTION. \ r 

disease that has never yet yielded to man's skill 
(consumption), and in a brief period passed 
from his earthly labors, leaving unfinished, and 
to the hands of others, the work in which he 
was so much interested. Dr. McMurtry, a 
promising young surgeon at that time, also of 
Danville, engaged at once in the same laudable 
undertaking begun by Drs. Jackson and Sayre, 
and in a few years thereafter the shaft was 
completed and stood ready to be unveiled; 
which occasion we will refer to in the closing 
chapter of this work. Great credit is due Dr. 
McMurtry for his perseverance and energy in 
this matter. 

The late Dr. Jackson, in his remarks relative 
to Dr. McDowell, seems to have been im- 
pressed with the idea that McDowell's first 
conceptions, his first promptings to make the 
experiment upon Mrs. Crawford, were but the 
teachings in embryo state of Mr. Bell — brought 
out and materialized, as it were, by McDowell. 

With all due deference to the lamented Jack- 
son, and to his earnest convictions, we must 
differ with him in his views ; for we are thor- 
oughly convinced that the idea of ovariotomy 
originated in the fertile brain of Dr. McDowell, 
although the words of Mr. Bell made a lasting 



12 INTRODUCTION. 

impression upon him; but he, McDowell, lived 
in an atmosphere replete with brilliant achieve- 
ments, generating and putting into execution 
some of the most remarkable surgical discov- 
eries and operations of any age — amongst men 
whose works are blended with historical events 
and reported in our American medical histories. 

It is not surprising, however, that Dr. Mc- 
Dowell, under the immediate influence and dis- 
cipline of such an intellect as was possessed by 
Mr. Bell, should have unconsciously imbibed 
the spirit of his thoughts and suggestions ; for 
certainly the preceptor was a remarkable man, 
and, at the time, in his glory. Ephraim Mc- 
Dowell studied under him in 1793 and 1794. 

John Bell was tall and commanding in ap- 
pearance, his movements were quick, and his 
speech the essence of eloquence. He was 
nervously excitable, and often allowed his feel- 
ings to carry him further than he wished. Those 
familiar with his habits say that they have often 
seen him so absorbed in his own ardent decla- 
mations as to deviate from the subject upon 
which he would be lecturing. 

He would speak of some foreign subject 
until his hour had expired, then looking at his 
watch, and realizing how ridiculous he must 



INTR OD UCT1 ON. x 3 

have appeared to the listeners would burst into 
tears. 

He was an experienced, bold operator, and 
understood the anatomy of the human body 
thoroughly. 

He excelled all other surgeons in his day, in 
easy flow of language and animated thought. 
His power of description was so great that even 
to the unprofessional person the reading of his 
Anatomy was pleasing and without fatigue ; and 
his surgery only added interest and recrea- 
tion. 

He gave himself great distinction by his 
studies in pathology of the arteries and by his 
ingenious treatment of arterial injuries. He 
devised many new and critical operations, and 
took a keen interest in removing the superflui- 
ties of the old surgery, not at all times sparing 
the new. 

Bound in the volume with the Life of Dr. 
McDowell is a complete copy of the memorial 
oration delivered by the late S. D. Gross, 
M.D., LL.D., D.C.L. Oxon., at Danville, Ken- 
tucky, on the occasion of the unveiling of the 
monument erected to the memory of Dr. Mc- 
Dowell, by the Kentucky State Medical Society, 
May 14, 1879, together with the proceedings of 



I4 INTRODUCTION. 

the Society relative to the erection of the mon- 
ument, and papers read on that occasion. 

The biography of Ephraim McDowell will 
interest every one who takes a pride in Ameri- 
can thinking, energy, and daring ; especially 
will it appeal to scientists — more than all, to 
every surgeon and every physician. Although 
the name of "the father of ovariotomy" is 
familiar to all surgeons, yet this fact cannot 
lessen an interest that must be felt in the life 
of Ephraim McDowell. 



CHAPTER II. 

ANCESTRAL LINE OF DR. EPHRAIM McDOWELL. 

"Of all the fierce and warlike cepts that 
ranged themselves beside the Campbells, under 
the leadership of the chiefs of that name, in the 
struggle so replete with deeds of crime and 
heroism, of oppression and stubborn resistance 
which had their fruit in the overthrow of the 
right line of the Stuarts, there were none more 
respectable, nor none that more perfectly illus- 
trated the best qualities of their race than the 
sons of Dowall. Sprung from Dougal, the 
son of Ronald, the son of the great and 
famous Somerled, they had, from the misty 
ages, marched and fought under the cloud- 
berry bush, as the badge of their clan, and had 
marshalled under the banner of the ancient 
Lords of Lorn, the chiefs of their race. The 
form of McDowell was adopted by those of 
the McDougal clan who held lands in Gallo- 
way, to which they, the Black Gaels had 
given its name. 

(*5) 



!6 ANCESTRY. 

"The latter branch became allied by blood 
and intermarriage with the Campbells. Pres- 
byterians of the strictest sect, and deeply 
imbued with that love of civil and religious 
freedom which has ever characterized the fol- 
lowers of John Knox, they found their natural 
leaders in the house of Argyle. In what 
decree related to the chiefs of the name was 
the McDowell who left behind him the hills of 
his native Argyleshire, to settle with others of 
his name and kindred and religion in the north 
of Ireland during the protectorate of Cromwell, 
cannot be actually stated ; he was, so far as can 
be gleaned from vague traditions, one of the 
most reputable of the colonists who there 
founded the race known as the 'Scotch-Irish,' 
the characteristics of which have since been 
so splendidly attested by its heroes, scholars, 
orators, theologians, and statesmen all over 
the world. 

"This Scotch colonist, McDowell, had among 
other children a son named Ephraim, which of 
itself indicates that he was a child of the Cove- 
nant. It was fitting that Ephraim McDowell 
should become at the early age of sixteen years 
one of the ' Scotch-Irish ' Presbyterians who 
flew to the defence of heroic Londonderry on 



ANCESTRY. 1 y 

the approach of McDonnell, of Antrim, on the 
9th of December, 1688, and that he should be 
one of the band who closed the gates against 
the native Irishry intent on blood and rapine. 
During- the long- siege that followed, the 
memory of which will ever bid defiance to the 
effacing hand of time, and in which the devoted 
preacher George Walker and the brave Murray 
at the head of their undisciplined fellow-citizens 
— farmers, shopkeepers, mechanics, and ap- 
prentices — but Protestants, Presbyterians, suc- 
cessfully repelled the assaults of Rosen, Mar- 
mont, Persignan, and Hamilton, the McDowell 
was conspicuous for endurance and bravery in 
a land where all were brave as the most heroic 
Greek who fell at Thermopylae. 

" The maiden name of the woman who be- 
came the worthy helpmate of the Londonderry 
soldier-boy was Margaret Irvine, his own full 
cousin. She was a member of an honorable 
Scotch family who settled in Ireland at the same 
time as their kinspeople, the McDowells. The 
names of Irvin, Irvine, Irving, Irwin, and Er- 
win are identical — those bearing the name 
thus variously spelled being branches from the 
same tree. The name was and is one of note 
in Scotland, where those who bore it had inter- 



1 8 ANCESTRY. 

married with the most prominent families of 
the kingdom, breeding races of soldiers, states- 
men, orators, and divines. 

"Ephraim McDowell who fought at Boyne 
River, as well as at Londonderry, was already 
an elderly man when, with his two sons John 
and James, his daughters Mary and Margaret, 
and numerous kinsmen and co-religionists, he 
emigrated to America to build for himself and 
his a new home. In his interestino- Sketches 
of Virginia, Foote states that he was accom- 
panied to Virginia by his wife, and that his son 
John was a widower when he left Ireland ; but, 
as in the deposition of Mrs. Mary E. Green- 
lee, the daughter of Ephraim, her father, her 
brother John, her husband, and herself are 
designated as composing the party emigrating 
to Virginia from Pennsylvania, and no mention 
is anywhere made of her mother, Mr. Foote 
is probably in error, and the uniform tradition 
of the family is more likely to be correct— that 
the wife of Ephraim McDowell died in Ireland, 
and that John McDowell had never been mar- 
ried until he came to America. 

"The exact date of his arrival in Pennsyl- 
vania is not known. The journal of Charles 
Clinton — the founder of the historic family of 



ANCESTRY. jg 

that name in New York — gives an account of 
his voyage from the county Longford, in the 
good ship 'George and Ann,' in company with 
the 'John of Dublin,' having many McDowells 
aboard as his fellow-passengers. The ' George 
and Ann' set sail on the 9th of May, 1729. 
On the 8 th of June a child of James McDowell 
died, and was thrown overboard ; several other 
children of the same family afterward died ; 
also a John McDowell, and the sister, brother, 
and wife of Andrew McDowell. The ship 
reached land on the coast of Pennsylvania on 
the 4th day of September, 1729. Whether or 
not the conjecture that Ephraim McDowell 
was a passenger with his kindred on board this 
ship at that time is correct, it is certain that 
about the same time he and his family and 
numerous other McDowells, Irvings, Camp- 
bells, McElroys, and Mitchells, came over 
together and settled in the same Pennsylvania 
county. 

"In Pennsylvania Ephraim McDowell re- 
mained several years. There his son John was 
married to Magdelena Wood, whose mother 
was a Campbell, and, as tradition has it, of the 
noble family of Argyle. There Samuel (the 
father of Dr. Ephraim McDowell the subject 



20 



ANCESTRY. 



of this work) the eldest son of John and Mag- 
dalena McDowell, was born in 1735. There 
too, probably, Mary, the daughter of Ephraim, 
met, was beloved by, and married James 
Greenlee, a Presbyterian Irishman, of English 
descent, and said to have been remotely de- 
scended from the Argyle-Campbells. 

''Some years before, a near relative of Eph- 
raim McDowell, by name John Lewis, had left 
Ireland a fugitive. Sir Mungo Campbell, an 
oppressive landlord, had attempted in a lawless/ 
and brutal manner to evict him from premises 
of which he had a freehold lease, had slain 
before his eyes an invalid brother, and with 
one of his cruel henchmen had died the death 
of the unrighteous beneath the strong hand of 
Lewis. First seeking refuge in Portugal, where 
lived a brother of his wife, he was by him 
advised to find a safer asylum in the great cen- 
tral valley of Pennsylvania, whither were then 
flocking many of the Protestants of Ulster. 
His first resting-place was at Lancaster, where 
he was in time joined by his sons Samuel, Tho- 
mas, and Andrew, and by his noble wife Mar- 
garet Lynn. The latter was a native of Ire- 
land. Her ancestors, the chiefs of their clan, 
derived their patronymic from the beautiful 



ANCESTRY. 2 I 

loch on whose banks in Scotland nestled their 
homes, and in the mountains, reflected by the 
translucent waters of which, they hunted. He 
landed in Pennsylvania the same year that 
brought the McDowells to America — 1729. 
That John Lewis and Ephraim McDowell were 
related and had been friends in Ireland, ap- 
pears from the deposition of Mrs. Mary 
Greenlee, the daughter of the latter, in 1806 in 
the suit of Joseph Burden vs. Alex. Cueton 
and others. The degree of the kinship is not 
stated ; but from the similarity of Christian 
names in the two families, and other circum- 
stances, it is believed their mothers were 
sisters. 

"James McDowell, the second son of the 
Londonderry soldier, had planted corn and 
made a settlement on the South River, in the 
Beverly Manor, in the spring of 1737 ; and 
thither the remaining members of the family 
determined to proceed and pitch their tents. 
Accordingly, in the fall of the year, Ephraim 
and John McDowell and James and Mary 
Greenlee left Pennsylvania, traversed the lower 
valley of the Shenandoah, intending to locate 
not far from John Lewis, and had reached 
Sewell's creek, where they went into camp. 



22 



ANCESTR Y. 



The fires were lighted and arrangements made 
for the evening meal, when a weary stranger 
coming up solicited their hospitality. It was Ben- 
jamin Burden (or Borden as the name is spelt by 
those of the family who clung to New Jersey, 
and gave its designation to Bordentown), an 
Englishman who had recently come over as 
the agent of Lord Fairfax, the proprietor of 
the Northern Neck. Meeting at Williams- 
town with John Lewis in 1736, he had 
accepted the cordial invitation of the latter 
to visit him at Bellefonte, Pennsylvania, had 
chased the roaming buffalo with the hos- 
pitable Irishman and his stalwart sons, and 
with their assistance had taken a buffalo 
calf, which, carrying as a trophy to Williams- 
burg, he presented to Governor Gooch.*. 
Pleased with what was then a curiosity in tide- 
water Virginia, and anxious, besides, to pro- 
mote the extension of the frontier and the 
settlement of hardy pioneers, as a means of 
protection and defence to the more populous 
lower country, Sir William issued to Burden a 
patent for 500,000 acres of land or any less 
quantity, situated on the Shenandoah or James 
River, not interfering with previous grants, on 
condition that, within ten years, he should set- 



ANCESTRY. 2 \ 

tie on the lands so located not less than one 
hundred families ; one thousand acres for every 
family settled or cabin built, with the privilege 
of purchasing an additional adjacent one thou- 
sand acres, at one shilling per acre. Making 
himself known to the McDowells, and produc- 
ing the patents as proof of his rights, he in- 
formed them that he had located ten thousand 
acres in the forks of the James River, to which 
he could not find his way, and stated he would 
give one thousand acres to any one who would 
pilot him to his possessions. 
/ "John McDowell was a man of education, 
and a practical and skilful surveyor. He 
accepted Burden's proposition ; writings were 
entered into to complete the agreement, and 
finally the party agreed to settle in ' Burden's 
Grant' and to assist him in conforming to its 
conditions. The next day proceeding to John 
Lewis' and remaining there a few days until 
all the stipulations of the contract could be 
reduced to writing, they went on until coming 
to the lands upon which Burden had the privi- 
lege to enter, building their cabins in what is 
now Rockbridge County, not far from the pres- 
ent town of Lexington — Ephraim and John 



24 ANCESTRY. 

McDowell and James Greenlee, the first three 
settlers in all that region. 

"Complying with their agreement with Bur- 
den, they immediately entered into communi- 
cation and opened negotiations with their 
kindred friends, and co-religionists in Pennsyl- 
vania, Ireland, and Scotland ; soon drawing 
around them other Scotch and Scotch-Irish 
families — McClungs, McCues, McCowns, Mc- 
Elroys, McKees, McCampbells, McPheeters, 
Campbells, Stuarts, Paxtons, Syles, Irvines, 
Caldwells, Calhouns, Alexanders, Cloyds — 
names which since have gloriously illustrated 
every page of Western and Southern history. 
In the field, at the bar, in the pulpit, in the 
Senate, on the bench, on the hustings, every- 
where by their courage, eloquence, learning, 
and patriotism, they have made themselves 
conspicuous ; making famous their own names, 
and building up the country with whose history 
and growth they are inseparably identified. 

"Burden lived on the grant until near the 
time of his death in 1742. Having, through 
the McDowells, fulfilled the conditions of the 
'grant,' Burden induced his son-in-law, James 
Patton, to seek an increase of fortune in the 
new world. 



AXCESTRY. 2 r 

''Remarkable in many ways, other than the 
great age of more than a century to which he 
lived, the span of Ephraim McDowell's life 
covered the overthrow of the Stuarts, the rise 
or the House of Hanover, the establishment of 
the Empire of Britain in India and over the 
seas, the wresting of New York from the 
Dutch, and the expulsion of the French from 
North America ; the erection of the electorate 
of Brandenburg- into the kingdom of Prussia ; 
the victories of Marlborough and Eugene, of 
the great Frederick, the consolidation of the 
Russian Empire under Peter and his succes- 
sors, the opening of the great West by the 
daring pioneers, and the growth of liberalism 
in Great Britain, France, and America. 

"Foremost by reason of influence and 
energy of the virtuous and hardy community, 
he and his associates erected school-houses 
and churches in the valley even before they 
constructed forts. Eminently useful and prac- 
tical in the character of his mind and the man- 
ner of his life, Howe records the fact that he 
built the first road across the Blue Ridge, to 
connect the valley with the tidewater country, 
at once affording a mode of egress for the 
production of the former, and facilities for 



26 ANCESTRY. 

receiving from the merchants of the latter the 
manufactures of the old world. Religious, 
moral, intelligent, and shrewd, the singular 
and beneficent influence he acquired among 
the independent and intrepid spirits by whom 
he was surrounded, was a natural tribute to 
his virtue and sagacity, and to the unflinching 
devotion to the cause of civil and religious 
liberty he had all his life upheld. 

"It is scarcely necessary to state of such a 
man, at once hospitable and provident, that he 
failed not to use the opportunities with which 
fair and generous nature had surrounded him 
to reap and store a fortune considered very 
large in those days. Retaining full possession 
of all his faculties to the very last, he died not 
until the outbreak of the Revolutionary war, 
and not until he had heard praises bestowed 
on his grandchildren for good conduct shown 
at the battle of Point Pleasant." 1 

John McDowell, the father of Samuel Mc- 
Dowell, fell in battle with the Indians, in the 
year 1 743. He commanded a company of brave 
men, who fought the savages desperately, but 
were compelled to retreat, when the Indians 

1 Historic Families of Kentucky. 



AXCESTRY. 27 

massacred the leader and eight of his men. 
The survivors, being completely routed, 
escaped as best they could. 

Rev. W. W. Foote, in his interesting 
Sketches of Virginia, says : 

"The burial place of these men, the first 
perhaps of Saxon race ever committed to the 
dust in Rockbridge County, you may find in a 
brick enclosure on the west side of the road 
from Staunton to Lexington, near the red 
house or 'Maryland Tavern,' formerly the resi- 
dence of John McDowell. Entering the iron 
gate and inclining to the left about fifteen 
paces, you will find a low, unhewn limestone 
tomb, about two feet in height, on which, in 
rude letters, by an unknown, unpractised hand, 
is the following crude inscription : 

Heer lyes 
the boddy of John Mack 

Dowell. 
died. 

December — 1743. " 

John McDowell left three children, Samuel, 
James, and Sarah. James remained in Virginia, 
consequently inheriting a handsome estate. 
He married Miss Sarah Preston, whose family 
were closely identified with the interests of 



2 8 ANCESTR Y. 

Virginia. Three children were born to them. 
The second daughter married Col. Thomas H. 
Benton, a once prominent politician. He was 
several times United States Senator, and was 
for many years identified with Missouri's inter- 
ests and politics. 

Samuel McDowell, the first-born of John 
(and grandson of old Ephraim, of London- 
derry), and the father of Dr. Ephraim Mc- 
Dowell, the subject of this work, was born in 
the colony of Pennsylvania, October 29, 1735. 
On the 17th day of January, 1754, in Rock- 
bridge County, Virginia, at the age of eighteen 
years, he was married to Miss Mary McClung, 
daughter of John McClung and Elizabeth Alex- 
ander, the lady being born in Ireland, October 
28, 1735, and being by one day the senior oi 
her husband. She, Elizabeth Alexander, was 
the daughter of Archibald Alexander and Mar- 
garet Parks, and was born at ''Manor Cunning- 
ham," Scotland, and was married in Ireland, 
December 31, 1734. 

Samuel McDowell and his wife Mary had 
eleven children born to them, and Ephraim 
was the ninth child. For many years Judge 
Samuel McDowell was engaged in public life, 
and held many high positions of trust. He 



ANCESTR Y. 2 Q 

served six different times as chairman of the 
State Convention before the election of a Gov- 
ernor. He was a member of the legislature 
several terms. He was colonel of a regiment 
in the battle of Guildeford, North Carolina. He 
was the first United States judge for Kentucky,, 
and was president of the convention which 
framed the constitution of that State in 1792. 
When Spain opened negotiations with Ken- 
tucky to have that State declare its indepen- 
dence, he was an active worker and prominent 
politician. In the year 1782 he was appointed 
by the Virginia Assembly a land commissioner. 
In 1784, many flattering inducements being 
offered him, he removed with his family to 
what is now known as Mercer County, Ken- 
tucky; and in 1786 he was one of the presiding 
judges at the first county court held in that 
State, the Kentucky District. From that date 
he was given the title of Judge, and was always 
known afterward as Judge Samuel McDowell. 

In the year 1785 he was chosen to preside 
over the convention which met in the rural 
village of Danville, then the county seat of Mer- 
cer County, Kentucky ; he was likewise chosen 
to preside over all the subsequent conven- 
tions which assembled to discuss the means of 



3 o ANCESTR Y. 

attaining an end so commonly desired. His 
irreproachable character, his judicial temper, 
his solid attainments, and matured convictions 
possessed him of the universal confidence. He 
was admirably qualified for the position that 
his destiny allotted him to fill, and it was by the 
patient discretion and calm, considerate judg- 
ment of the presiding officer, and the deter- 
mined, cool patriotism of others like himself, 
that the difficulties of a separation from Vir- 
ginia were peacefully and legally overcome, 
and the numerous advantages commercially 
— the unobstructed and free navigation of 
the Mississippi — eventually and satisfactorily 
reached. In the unsettled and perilous times 
connected with the early history of the West, 
and especially with pioneer life in the State of 
Kentucky, he was the " central figure of an 
historical group of men conspicuous, like him- 
self, for courage, intelligence, fortitude, endur- 
ance, dignity of character, and mental poise. 
All were representative men, were types of a 
cultivated class and of a vigorous, aggressive, 
and enduring race." 1 

Judge McDowell was appointed aid-de-camp 
by old " King's Mountain" Shelby, by whose 

1 Vide The Genesis of a Pioneer Commonwealth. 



ANCESTRY. 



31 



side he had fought at Point Pleasant. He was 
also commissioned by General Washington, 
under whose eye he had served in the campaign 
on the Monongahela in 1755, and who well 
knew his worth. In every position he honorably 
acquitted himself. Years afterward a singular 
coincidence occurred in his family — the marriage 
of his son Ephraim to the daughter of "King's 
Mountain" Shelby. The official records also 
show that Judge McDowell commanded a com- 
pany of scouts, that he was a gallant and brave 
officer, and that he did valuable service during 
that memorable campaign in which the power 
of the Shawanese was broken. 

After many years of useful service to his 
country, an honored and respected citizen, es- 
teemed for his strong sense, for an integrity 
that never succumbed, for an unassailable pri- 
vate as well as public life, he lived beyond his 
three score years and ten ; lived to serve and 
bless the God of his creation ; and as he lived a 
Christian life, so he died triumphant in his faith, 
expecting to receive the inheritance promised 
through the Holy Prophets. He calmly and 
peacefully passed away September 25, 18 17, 
at the ripe age of eighty-two years, at 
the residence of his son, Colonel Joseph 



^2 ANCESTRY. 

McDowell, whose home was near Danville, 
Kentucky. 

We herewith note the children of this re- 
markable pioneer : 

Their first-born "Magdaline McDowell,'' was 
the twin to Sarah McDowell. The children 
were born October 9, 1755. Magdaline was 
married to Andrew Reid, and Sarah married 
Caleb Wallace. 

John McDowell was born December 8, 1757. 
He married his cousin, Sarah McDowell. He 
was an officer in the Revolutionary war. 

James McDowell was born April 29, 1760, 
and married Mary Lee, of Virginia. He also 
served in the Revolutionary war, and was 
colonel in the war of 18 12. He fought in 
various Indian conflicts and wars of Gov- 
ernor Scott's and Hopkin's campaign. 

William McDowell was born March 19, 
1762. He married Margaret Madison, a cou- 
sin of President Madison, and sister of Gover- 
nor Madison. 

Samuel McDowell was born March 8, 1764. 
Married Annie Irvine. He filled with honor 
the position as first United States Marshal in 
the State of Kentucky. 

Martha McDowell was born June 26, 1766. 



ANCESTR K 



33 



She married Colonel Abram Buford, a daring, 
courageous Revolutionary officer. 

James McDowell was born September 13, 
1768. He was an officer in the war of 18 12, 
and Adjutant-General of Governor Isaac Shel- 
by's army in Canada. 

Ephraim McDowell, justly entitled "the 
father of ovariotomy," was born November 11, 
1 771. He married Sarah Shelby, the daughter 
of Governor Isaac Shelby, of whom we will 
speak more hereafter. 

Mary McDowell was born January 11, 1774. 
Her marvellous beauty gave her great reputa- 
tion ; her gentle, amiable manners won her 
hosts of friends ; and her Christian character 
illumined her pathway of life. She married 
Alexander Keith Marshall, brother to John 
Marshall, Chief Justice of the United States. 

Caleb McDowell, the youngest child, was 
born April 17, 1776. He married his relative, 
Betsy McDowell, daughter of Major Joseph 
McDowell, of North Carolina. 



CHAPTER III. 

EARLY LIFE OF EPHRAIM McDOWELL AND HIS 
EDUCATIONAL ADVANTAGES. 

When Ephraim McDowell was only thirteen 
years of age, he came w'ith his father from 
Rockbridge County, Virginia (the place of his 
nativity), to Danville, Kentucky. The party 
experienced many long days of perilous travel, 
and were subjected to privations that the 
youth of the present period would shrink from 
encountering ; but this brave and courageous 
boy kept a stout heart and not a murmur es- 
caped his lips. He had unbounded confidence 
in his father's judgment, and felt that whatever 
modification of his life was to come out of 
the change being made must result in his good 
and aggrandizement. 

Even at that tender age he displayed both 
unusual judgment and wonderful reasoning 
power. His youthful mind contrasted in its 
development favorably with those of much 
greater maturity. He was thoughtful and 

(34) 



EARLY LIFE. 35 

studious, and it was frequently remarked by 
members of his family, and those interested 
in his welfare, that when his schoolmates and 
associates would call for him to accompany 
them to their playground, he would frequently 
decline, resisting their persuasions and return- 
ing to his books and studies — displaying at 
once that indomitable will over the desire of 
the heart : for what boy is there that does not 
enjoy the freedom from school halls and per- 
plexing studies ? He realized, even at this 
early age, that he had a higher purpose in life 
than personal pleasure, that he had a mind 
to store with well-trained thoughts, and that 
the body was simply the servant to the will. 
He early received a religious training, and as 
soon as he could lisp the name of God was 
taught to reverence the word, and never to use 
it idly or in vain. Hence, with such parents 
to mould his character, to bend the twig as it 
should be bent, to guide his footsteps through 
life's thorny pathway, cold and perverse would 
have been his heart had it denied such holy 
impressions or not have been influenced and 
elevated by them. 

After traversing the vast wilderness, with 
here and there occasionally a hewn-log cabin 



36 EARL Y LIFE. 

seen peering above the heavy undergrowth, 
nothing of interest occurring to dispel the lone- 
liness of the solitary journey, they reached, in 
due course of time, the small village of Dan- 
ville, at that time the seat of the most refined 
and cultured society in that far western land. 
The surrounding country presented an inviting 
appearance. The soil was loamy and friable. 
Clear and rippling brooks meandered through 
the timbers, making a natural irrigation that 
offered fine inducements to the agriculturist, 
who saw the advantages immediately derived 
from such soil, and grasped the opportunity of 
cultivating the same by permanently locating 
with their families in such a country. 

After Samuel McDowell settled with his 
family in Danville, he induced many of his 
friends to leave Virginia and come to Ken- 
tucky. Even before the sturdy citizens engaged 
in business or farming, they organized to 
establish schools and churches, that their chil- 
dren might not waste their precious time. 
They formed resolutions among themselves to 
this effect: "Many of us, and our forefathers 
left our native land and explored this once 
savage wilderness, to enjoy the free exercise 
of the rights of conscience and of human na- 

o 



EARLY LIFE. 37 

ture. These rights we are fully resolved, with 
our lives and our fortunes, inviolably to pre- 
serve. Nor will we surrender such estimable 
blessings, the purchase of toil and danger, to 
any ministry, to any parliament, or any other 
body of men upon earth, by whom we are not 
represented, and in whose decision we have 
no voice." 

Such resolutions our forefathers framed, and 
strictly adhering to them, made for themselves 
happy homes and a prosperous country. 

Ephraim McDowell developed early into a 
tall, erect, and commanding figure. He was 
considered strikingly handsome, having lustrous 
black eyes that seemed to penetrate into the 
very thoughts of those who looked into them. 
His refinement and intellectual powers were of 
the highest type, and his friends predicted for 
him a brilliant career in whatever profession 
he choose to follow. Young as he was, he 
had an inquisitive mind, searching for new 
truths ; and to attain these he was a constant 
reader. He seemed possessed with wonderful 
magnetism, and his ardent temperament won 
him some lasting friends, which he retained to 
the time of his death. He was a fine conver- 
sationalist, and his ready wit was most pleasing. 



38 EARLY LIFE. 

He enjoyed a good joke, and took great pleas- 
ure in perpetrating innocent pranks upon his 
friends. The profession of medicine was his 
own choice, and he was especially fond of the 
literature pertaining to surgery. 

He received his early education at the classi- 
cal seminary of Messrs. Worley and James, 
who first taught at Georgetown, Kentucky, and 
afterward at Bardstown in the same State. He 
then went to Virginia and entered the office of 
Dr. Humphrey, of Staunton, as a medical stu- 
dent, where he remained for two or three years, 
closely applying himself to his studies. 

We know but little of this Dr. Humphrey, 
save that he was a graduate of the University 
of Edinburgh, and in his day enjoyed a consid- 
erable local reputation and an extensive prac- 
tice in Staunton and its vicinity. The fact of 
his being a good instructor is highly probable. 
Another of his pupils, Dr. Samuel Brown, was 
one of the founders and one of the first corps 
of lecturers of the medical department of 
" Transylvania University" of Lexington, Ken- 
tucky, and rose to high distinction. 

In the years 1793 and 1794, Ephraim at- 
tended lectures at the University of Edinburgh, 
Scotland, contemporaneously with his country- 



EARL Y LIFE. *Q 

men, Drs. Samuel Brown (before alluded to), 
Hosack, and Davadge, of New York, also Dr. 
Brackenborough, of Virginia, all of whom sub- 
sequently attained eminence in the profession. 

While in attendance on the course of the 
University, he also took the private course of 
John Bell, who at that time was not a member 
of the faculty, and it would appear that the bril- 
liant prelections of this most able, eloquent, and 
gifted of the Scotch surgeons of that day must 
have impressed him profoundly. That portion 
of his course in which he lectured on the 
diseases of the ovaries, dwelling on the inevit- 
able death to which the victims were doomed, 
and merely suggesting the possibility of suc- 
cess attending any operation that might be at- 
tempted for removal of the organs, was certainly 
never forgotten by his auditor, for he carefully 
stored in his mind the principles and sugges- 
tions at this time enunciated by the Master, 
together with other impressions, which sixteen 
years later determined him to attempt his first 
ovariotomy, which operation has immortalized 
him, and opened to the broad field of surgery 
the abdominal operations ; and from that distant 
day (now eighty years ago) to the present time, 
countless thousands can testify to their being 



40 EARL Y LIFE. 

relieved and saved by the bold and daring ope- 
ration which he gave to the medical world. 

Through the kindness of Col. J. McD. Alex- 
ander, of Virginia, we have been furnished with 
and are indebted to him for the following inter- 
esting letters — not interesting alone for their 
antiquity, but as conveying an idea of the po- 
litical condition of the country at that early 
period when our forefathers were struggling 
for their rights. These letters were addressed 
to Ephraim McDowell during the time that he 
attended lectures at Edinburgh, and were writ- 
ten to him by his father and by Mr. Reid, his 
brother-in-law. 

Mercer County, State of Kentucky, 
February 10, 1793. 

Dear Ephraim : I have not heard from you 
since you left Rockbridge, and am very anxious 
to hear of your safe arrival in Scotland. I can 
with pleasure inform you that myself and all 
your friends in Kentucky are well, for which 
we have reason to be thankful to the great 
Author of our Being. We have not anything 
worth communicating since I wrote you last, 
when you were in Rockbridge. Our new gov- 
ernment seems to go on middling well, but 
our legislature seems very parsimonious. They 



EARLY LIFE. ^ 

have given our government ^300 a year, and 
the judges of the Court of Appeals ^200. The 
secretary ^100 and the auditor ^"ioo. The 
treasurer ^100, and the judges of the court of 
Oyer and Terminer ^30, but it is supposed 
that they will increase the salaries at their next 
meeting ; but I rather think they will not, as 
it [is] popularity the most of the members are 
seeking, and not to do right if they even knew 
it. The seat of government is fixed at Frank- 
fort, Kentucky, on the Kentucky River, where 
I have got a lot or two, one of which is for 
you, if you live to return, and choose to come 
to Kentucky, which I wish you to do. 

I would be glad to hear how you like your 
situation there, and how long you think it will 
be necessary for you to stay, for I assure you 
it will be very hard for me to send you a 
supply of money. But I will endeavor to sup- 
port you if in my power, and to enable you to 
bring with you some books, and a quantity of 
medicine to serve you some time, and to set 
up a decent shop. But I fear I will not be able 
to send you money sufficient./ But if you had 
it in your power to get credit for some of which 
you might think would be necessary, I will, I 
hope, be able in a short time after your return, 



42 EARL Y LIFE. 

to make a remittance to pay for the medicine. 
Is there no person trading to Scotland to whom 
you could apply ? 

But I need say no more on the subject for it 
is not to be expected that any person there 
could place so much confidence in you as to 
give you credit for one hundred pounds worth 
of books and medicine, and you must try to do 
the best you can, and steward well the little 
money you took with you. I may be able to 
send you some, which may be about fifty 
pounds. I will send you more if you need it, 
and it will be in my power. 

Give my best compliments to Mr. Brown 
and Mr. Watkins. Tell Mr. Brown his brother 
James is well ; also tell Mr. Watkins I saw his 
father not long since, who was well and had 
got a letter from him. Your mother seems to 
think much and longs to see you once more in 
Kentucky. You know of my small misfortune 
in my speaking. I am almost now persuaded 
that what Dr. Humphreys said is the case 
(to-wit), a swelling in the glands about the root 
of the tongue, as sometimes, especially in the 
morning, you would not observe it to hurt my 
speaking and I feel no difficulty, and after 
some time in the day it grows worse. Try and 



EARL Y LIFE. 43 

find out if any such case happens in the course 
of your business that you may help me. Let 
it be the swelling of the glands, or what I sus- 
pected, a touch of the palsy, I only add my best 
wishes for your happiness, and believe me to 
be your affectionate father, 

Samuel McDowell. 

N. B. — Your mother sends her blessings to 
you and hopes you will not forget your duty to 
God, who has always been so kind to you. 

Direction : 

Mr. Ephraim McDowell, Student, 

Edinburgh, 

Scotland. 
Care of Col. Gamble, 

Richmond. 

Letter to Ephraim McDowell from his 
brother-in-law, A. Reid, of Rockbridge County, 
Virginia. Note the length of time it required 
for letters to reach America a century ago, 
when they were written from Europe ; Ephraim 
McDowell's letter bearing date of March 4, 
1793, and the reply being written immediately 
upon receipt of Ephraim's letter, August 25, 

1793. 



44 



EARL Y LIFE. 



Rockbridge, Virginia, 
August 25, 1793. 



Dear Ephraim : I have just received yours 
dated March 4th last, by which I was agreeably 
informed of your safe arrival at Edinburgh. 
The opportunity you had of seeing so much of 
that old and well-cultivated country, must have 
been very agreeable. I hope it has and will 
ease your mind on that score until you com- 
plete your studies. 

I hope you will not take it amiss of a friend, 
to repeat the necessity of your diligence. 

Your father has, I expect, written you that 
he means to furnish you with ^300, including 
what you took with you from home ; which, 
from the statement in your letter of the neces- 
sary expenses, I am afraid will scarcely be suf- 
ficient without very great economy. 

I have had letters from Kentucky lately; 
your friends are all well there. Indians are 
still very troublesome on the frontiers from 
North to South. A treaty has been proposed 
by the government, I suppose more with a view 
of quieting the minds of members who are 
averse to the war, than an expectation of peace. 
By every act the Indians refuse treating on any 
other terms than making the Ohio River the 



EARL Y LIFE. 45 

line, which never will be complied with by the 
Government. The President 1 has called on 
the State of Kentucky for fifteen hundred vol- 
unteers. It is said they (with a considerable 
addition) will march about the first of next 
month. Report says that the commissioners 
who were sent to treat with the Indians are 
made prisoners and not permitted to return. 

We have agreeable news from France lately. 
It is said they have beat the combined armies, 
both by sea and land, and I hope will continue 
to do so until their freedom is established ; 
should the reverse take place the consequences 
might be of a serious nature to America. 
There is scarcely a doubt that the combined 
powers would attempt to suppress republican- 
ism here. 

Your brother Caleb came in about the first 
of March ; he will stay with me perhaps three 
years or better to learn the business of the 
office. When you return will expect you to 
take Rockbridge in your road to Kentucky. 
Dr. Falconer left Lexington in the spring and 
returned to the State of New Jersey. He sold 
out his shop of medicine to Dr. Campbell, who 

1 General Washington. 



4 6 



EARL Y LIFE. 



succeeded him in the practice and is in pretty 
good esteem. Dr. Falconer is expected every 
day to return. He intended settling in Buck- 
ingham County on the James River. 

In addition to the medical faculty at Staunton, 
there is a Dr. Mcintosh, who by a pompous 
advertisement, offers his services, and in order 
to introduce himself he says he studied at 
Edinburgh and attended the lectures of Mr. 
Monroe. Your sister, Caleb, Sallie, and the 
rest of the family join me in compliments to 
you. I am, dear Ephraim, respectively your 
friend and brother, A. Reid. 

Ephraim McDowell, 

Edinburgh, Scotland, 1793, A. D. 

The following letter was written by Judge 
Samuel McDowell (father of Ephraim) to his 
son-in-law, Mr. Andrew Reid, of Virginia: 

Mercer County, July n, 1792. 

Dear Sir : I have nothing worth notice to 
tell you, only that it gives us sorrow to part 
with Sally, but as you expressed a desire that 
she should come home, Joseph thought as 
Ephraim was amind to go to Europe next fall, 
he might as well go now and see him before 
he went way. I had it not in my power to do 



EARL Y LIFE. 47 

anything with the sheriff about your fees. I 
have talked to them, and none of them have 
collected them ; they say the people against 
whom they are cannot pay as they are mostly 
very poor. 

Whenever the courts begin to do business, I 
will move against all the sheriffs who have any 
of them, but I really fear little of them will ever 
be collected. Benton declares he will pay off 
the balance that he owes by Christmas next, 
he has paid me about £60 ; very little of it in 
money, some cows, pork, and orders on other 
people who have not yet paid. I think the 
whole I have paid you is £$°- A civil list 
warrant by Joseph, fifteen pounds to Ligert, by 
your order, and six pounds for the land war- 
rants. I sent you in all £$\. I expect to set- 
tle with Benton before long and know the 
exact amount he has paid, and will then let you 
know how much is in my hands, and in the 
meantime if you get any money from Evens or 
Fritte make use of it till I send you Benton's 
whole money or state his account to you. 

Joseph can tell you some of the proceedings 
of our Assembly. The revenue law taxes land 
at two shillings the hundred acres, and all 
people claiming land here must make return of 



4 8 EARL Y LIFE. 

it to the commissioner by February 9, 1795, or 
loose the land. I have not seen any of their 
laws — they are not printed, but Joseph can tell 
you something of several of them. I have not 
as much money as I intended to send by Eph- 
raim when he goes ; but perhaps he may have 
enough 'till I can send him a supply again; he 
will perhaps have upwards of ^200, and I 
wished him to have ^250. But I think he had 
not better carry it in money, as there may be 
danger of losing it, but take a bill on some good 
man in Edinborough or Glascow ; but if that 
should be protested it would be bad for Eph- 
raim. I can say nothing on the subject, you 
and him must do as you find it best. I leave 
the whole direction to you, and I hope he will 
act prudently. 

f If you have any doubt of his economy or 
prudence pray let me know, for I would not be 
for his going to Scotland, if he was of an im- 
prudent behavior in any respect whatever. I 
could wish to establish some way of sending 
him any little supplys from Richmond ; you and 
Joseph may lay some plan perhaps. Mr. Sin- 
clair can give you some assistance in fixing the 
matter. If Colonel Gamble lives in Richmond 
perhaps he may be a friend in the matter; But 



EARL Y LIFE. ^ 

I am too far from the scene of action to give 
any direction in the matter. 

I could wish you were here this fall, as there 
will be a number of clerks places to fill, and I 
believe you could get the first clerkship in the 
county, that is to the Court of Appeals. But 
I would not wish to advise you to anything of 
that kind, least you should be disappointed. 
But I am fully of opinion it might be better for 
your prosperity that you were living here. 

Are the people in and about Lexington as 
religious as they were some time ago ? My 
dear sir, religion is a most excellent thing, and 
that we should be all earnest to obtain, but 
the zeal of some of the Lexingtonians goes 
wild or carries them to extravagances and 
folly ; that is, in my opinion very foreign to 
true religion ; and will have a tendency to make 
them people very proud and unsocial, looking 
upon all who are acting like rational creatures 
to be the wicked ones on earth, and look down 
on them with contempt. I am persuaded that 
the way them people (or some of them) are 
acting", will inevitably lead to a savage or 
superstitious state in the course of one or two 
hundred years — perhaps in much less time. 
Those good people will not associate with the 

4 



50 EARL Y LIFE. 

wicked (as they call them) but meet only for 
religious worship or socially with their religious 
friends. Had that been the case formerly we 
had yet been in ignorance, but mankind mixing 
in assemblys for innocent amusement, culti- 
vates friendship and civilizes the world. It 
makes their manners more mild and friendly 
and removes that sourness that superstition 
and bigotry leaves on the mind. May you and 
me, my dear sir, be earnest to live in this world 
as not to give offense to any one, and still act 
like rational creatures ; for I am persuaded 
that the Divine Being cannot delight to see his 
creatures, that he has endowed with rational 
power, lay aside their reasoning powers and 
give themselves up to superstition. 

Give my love to Magdaline and your dear 
little family, and believe me to be with extreme 
affection, dear sir, 

Your affectionate father, 

Samuel McDowell. 

Mr. A. Reid, 

Rockbridge, Va., 1792, A. D. 



CHAPTER IV. 

RETURN FROM EDINBURGH. 

Upon his return to Danville, in the year 
1795, McDowell entered at once on the prac- 
tice of his profession. Commencing as he did 
with the eclat of an attendance upon the then 
most famous medical school of the world (for 
at that time Edinburgh held the position since 
occupied by Paris, and more recently by Vienna, 
as the centre of medical science), he soon as- 
sumed the first professional position in the 
community in which he lived, not uninterfered 
with, however, by envy and jealousy. His fel- 
low professors of medicine and surgery, aspiring, 
with himself, to fame and distinction, regarded 
McDowell's superior medical advantages with 
a jealous eye, as was proven by many acts and 
words of covert nature. 

Dr. McDowell made a speedy advance, his 
reputation extending, within a few years, 
throughout the entire Western and Southern 
country, all this wide region accepting him as 

(SO 



52 RE TURN FR OM EDINB UR GH. 

the first and leading surgeon west of Philadel- 
phia. 

Of Kentucky citizens of the preceding gen- 
eration, many obtained distinction in their 
respective pursuits, but it is doubtful if any of 
them builded so deeply the foundation of an 
enduring fame as did Ephraim McDowell, of 
Danville. While others wielded great powers, 
and rendered various services in their day and 
generation, Dr. McDowell inaugurated a work 
which continued to live and grow after the 
originator had passed from the scenes of his 
labors. 

By his originality, skill, and courage, he 
opened up a new departure in the science and 
practice of surgery which has advanced until 
now accepted as not wide of the crowning glory 
of that great and beneficent art. Through this 
departure thousands of women have been res- 
cued from certain and painful death. By his 
own hand he demonstrated the practicability of 
the new work his genius had devised, and he 
published the results of his labors. The crea- 
tion was complete in execution as well as in 
priority. He is recognized throughout the civ- 
ilized world, as the originator of a great depart- 
ment of surgical practice and as a benefactor 



mt 



RE TURN FR OM EDINB UR GH. 5 3 

to his race. His name is familiar to the stu- 
dents of medical science in every land and 
clime, forming, in the language of Fitz-Greene 
Halleck, one of the few, the immortal names 
that were not born to die. In every land the 
practitioner of surgery is utilizing amid the 
brilliant achievements of his art, and his efforts 
toward the restoration of life and health, the 
results of McDowell's work. In the rapid pro- 
gress of science, other hands and minds have 
now widened the scope and extended the appli- 
cation of his great operation, yet this but adds 
to the grandeur of the original step, and lends 
additional lustre to the fame of him who led the 
way. 

With the exception of J. Marion Sims, a 
native of South Carolina, no physician on this 
continent has contributed such far-reaching 
and potential influence toward advancing and 
enriching the resources of surgical science. 
Indeed these two great American surgeons 
founded the modern science of gynecology, 
which has brought to American medicine and 
American physicians so much of the renown 
and esteem in which they are regarded in all 
foreign countries. 

Since the early history of the commonwealth, 



54 RE TURN FR OM EDINB UR GH. 

the medical profession of Kentucky has ranked 
alongside the most advanced of the entire 
country, and within her borders was estab- 
lished one of the oldest and most renowned of 
America's medical schools. But great discov- 
eries springing from that wonderful creative 
faculty which utilizes all previous research in 
conception, and combines skill, courage, and 
intelligent penetration of undiscovered lines of 
thought in execution, are uncommon in all 
branches of learning. To rend the veil which 
conceals the mysteries of science is allowed to 
comparatively few, but such privilege fell to the 
lot of Ephraim McDowell. 1 

As has been previously stated, McDowell 
came fresh from the University of Edinburgh, 
and selected as his future home Danville, Ken- 
tucky, a small rural village composed of an 
aristocratic little colony, where he soon dis- 
played such talent as a surgeon and physi- 
cian, that it was not long before he divided 
honors with the great men of the State, espe- 
cially those of Lexington City ; and while, at the 
latter point, the enterprising founders of what 
was soon to be the first great medical school 

1 See Butler's History of Kentucky, written in the year 
1834. 



RE TURN FR OM EDINB UR GH. 1 5 

of the West were busying- themselves with 
schemes for the permanent establishment of 
Transylvania University, Ephraim McDowell, 
at Danville, laid the foundation for a great 
revolution in the "ars chirurgiae." 

While measures were being consummated 
for laying a surgical foundation that would not 
crumble and fall by Time's blighting hand, 
plans for future personal comfort and happi- 
ness were also being weighed and stored in 
his well-balanced mind. He was thoroughly 
domestic in his habits and tastes, and admired 
the pure and ennobling characteristics of a 
good and elevated woman. At the age of thirty- 
one years he decided to select a suitable ^help- 
mate and companion for life. 

Having met Miss Sarah Shelby, the daughter 
of his father's tried and trusted friend (Gover- 
nor Isaac Shelby), his heart quickly became 
deeply interested in her, while his attentions, 
marked from the first, soon culminated in vows 
of love, which love, happily for him, was ar- 
dently reciprocated. In the year 1802 the two 
were married at the home of the bride's parents 
a few miles distant from Danville. 

Miss Shelby was the highest type of a 
noble Christian woman, and certainly a most 



ij 6 RE TURN FR OM EDINB UR GH. 

suitable person to be the wife of Ephraim Mc 
Dowell. She was remarkable for her intelli- 
gence and keen perceptive powers. Her 
strength of character, sound common sense 
and domestic qualities, combined with a lovable 
disposition, won for her the admiration and 
encomiums of those who were fortunate enough 
to know her. She was also gifted as a writer, 
and many beautiful and original thoughts 
emanated from her well-stored mind. She 
could never be induced, however, to give to the 
public any of her writings, though numerous 
pages of manuscript were stored away ; her 
most choice and original pages being carried 
to the garret, to moulder, and finally pass out 
of existence. In appearance Miss Shelby was 
graceful and of commanding height. She was 
dignified and reserved in manner, although her 
brilliant flashes of wit and innocent double 
entendre were not unfreely furnished the social 
circle in which she moved. Her tastes were of 
that elevated, refined nature that makes woman 
most attractive. Although but eighteen years 
of age at the time of her marriage, she pos- 
sessed a mind matured and observing to a 
degree that reflected large credit on her mater- 
nal rearing. She was a devoted member of the 



RE TURN FR 03/ EDINB UR GH. g n 

Episcopal church, and, believing that a true 
Christian should rise above the petty annoy- 
ances incident to the daily life of all, she verified 
her belief by her acts of devotion. Her influ- 
ence over her husband was so great that shortly 
after marriage he connected himself with the 
church, remaining a faithful and zealous mem- 
ber to the time of his death. 

The present site upon which Christ Church 
in Danville stands, was a donation from him. 
He was also an especial friend to "Centre Col- 
lege," cooperating largely toward its founda- 
tion both by his influence and liberal donations 
of money. He was, indeed, one of its original 
corporators and curators. This, too, although 
its government was by the Presbyterian Church. 
He was a man of liberal views, neither bigoted 
nor sectarian. He saw and appreciated the 
enjoyment and happiness derived from leading 
a religious life. 

He was fond of books, and at the time of 
his death possessed an excellent library for 
the period in which he lived. He constantly 
made additions to his medical works, and 
whenever a new book of merit was issued he 
would invariably purchase it. The iron grasp 
of progress had a firm hold on him and would 



53 RE TURN FR OM EDINB UR GH. 

not relax its grip until he had arrived at the 
pinnacle of fame and achieved the earnest 
desire of his heart. 

He had a fair knowledge of the classics, yet 
he gave most of his leisure time to belles-lettres 
and history, both of which he was very fond of 
studying. He also gave much and earnest at- 
tention to biology. 

When leisure hours allowed opportunity he 
would take long strolls through beautiful wood- 
lands convenient to his home. In one of these 
walks accompanied by his wife, he discovered 
lying upon the sand, bordering a clear stream 
of water which meandered through his farm, a 
number of small pale blue eggs, resembling 
those of some diminutive bird. The two gath- 
ered these and supposing them to be bird's 
eggs, carried them to their home, placing them 
in a saucer in a warm, dark closet. Hav- 
ing occasion to punish one of his grandsons, 
he could think of nothing more severe for 
the disobedient little fellow than to lock him 
up in this closet for a little time. The boy 
had not been confined in his prison but a 
few moments, when he screamed dreadfully, 
at the same time frantically calling- out, "Oh! 
let me out, grandpa ; there is something crawl- 



RE TURN FR OM EDINB UR GH. 5 g 

ing all over me ; please let me out. I will be 
good." The doting grandparent could not 
resist the entreaties of the terrified child, and 
on unlocking the door, imagine his horror and 
surprise to find the closet swarming with young 
snakes, every egg having hatched out. Fortu- 
nately, nothing worse came of the incident than 
the sad fright experienced by the child. The 
grandfather never again, however, attempted 
to punish his little grandson. 

Dr. McDowell was a man of the tenderest 
emotions and sympathies. His manner was 
plain and unassuming. He invariably dressed 
in black, adhering closely to the silk stock and 
ruffled linen. He was scrupulously neat in his 
person. 

He did not use tobacco in any form, and 
often expressed himself as having a disgust for 
a man that chewed. Although strictly temper- 
ate, he would occasionally take a small drink of 
whiskey or cherry bounce (the latter his favor- 
ite beverage) when he had experienced any 
unusual exposure. He always kept the finest 
drinks upon his sideboard for the pleasure of 
his guests and friends. 

He employed an overseer to manage his 
farm, and taking a deep interest in raising fine 



6o RE TURN FR OM EDINB UR GH. 

horses and swine, he closely observed the man- 
ner of rearing and fattening them. It was from 
a familiar process in this connection that he 
gathered important facts, which resulted in his 
experiment upon Mrs. Crawford. 

Being of Scotch extraction, it would naturally 
be inferred that the gifted Burns was a favorite 
with him, and from his familiarity with the Scot- 
tish dialect, acquired while in Edinburgh, his 
readings and quotations were given with idiom 
as perfect as if he had been a native of old 
"KeeKee." 

Six children were born to Ephraim and 
Sarah McDowell. Their first-born, "Shelby," 
was a bright and promising boy ; unfortunately, 
in the absence of his father, he inhaled a wheat 
spear into his windpipe, and expired before 
medical aid could reach him. 

The second son, "Wallace," a gentle, quiet, 
and greatly beloved son, lived to attain man- 
hood and married Miss Mary Hall. For several 
years he was engaged in mercantile pursuits, 
and was esteemed an upright and conscien- 
tious business man. A singular fact worthy to 
be noticed, was that Wallace McDowell could 
not look at the blood of any animal without 
fainting. It was evident that he was not born 



RE TURN FR OM EDINB UR GH. £ 1 

to be a surgeon. He lived to rear a family of 
children, dying only a few years back in Mis- 
souri. 

Susan McDowell, the eldest daughter, mar- 
ried Colonel David Irvine, of Richmond, Ken- 
tucky. Shejdi^4e^vin^^ou4^children. Mary 
their second daughter, married her cousin once 
removed, George Young, a wealthy and pros- 
perous farmer of Shelby County, Kentucky. 

Mary McDowell, not unlike her aunt, and 
bearing the same name, was a marvellously 
handsome woman ; indeed, her blended beauty 
of face, form, and character, gave her both 
enviable reputation and celebrity. The sweet 
and fascinating expression of her face was but 
the reflection of a mind stored with choice 
knowledge, while her character was resplend- 
ent with deeds of mercy, love, and charity. 
The poor idolized her, for during her brief ex- 
istence (having died at thirty years of age) 
she had proved herself a friend to them by her 
many acts of benevolence. She left four small 
children ; they never knew the depth of such a 
mother's love. 

Adaline McDowell, the third daughter, mar- 
ried a prominent politician, Judge James Deade- 
rick, of Tennessee. She was an unusually 



62 RE TURN FR OM EDIXB UR GH. 

bright and clever woman, kind and lovely in 
disposition. She still survives. 

Catharine, the fourth and youngest child, 
married Colonel A. A. Andison, of Tennessee. 
She also survives her parents, and has lived to 
see her children grown. 

The father of Mrs. McDowell, Governor 
Isaac Shelby, of "King's Mountain" fame, was 
one of the most prominent and influential citi- 
zens in the State of Kentucky. Emigrating at 
an early day to that vast wilderness and be- 
coming closely identified with the interests of 
the country, by the provisions of the Constitu- 
tional Convention at Danville, Kentucky, on 
the fourth day of June, 1792, he was chosen 
Governor of the State ; on the sixth day of the 
succeeding May he met in person and addressed 
the Legislature after the custom of the British 
monarchs, which custom was imitated by many 

Governors and by President Washington. 1 He 
j <_> 

served in the Revolutionary war with honor 
and distinction. He planned and was second in 
command at the battle of ''King's Mountain," 
where one thousand British prisoners were cap- 
tured, and for his chivalry and daring deeds he 
was awarded by the Congress of the United 

1 See History of Kentucky. 



RE TURN FR OM EDINB URGH. fa 

States a handsome gold medal, now in the pos- 
session of the State of Kentucky, and cared for 
/ at Frankfort, the Capitol. His son presented 
this medal to the State as a relic of meritorious 
antiquity. 

His election to the chief magistracy was an 
act of wisdom on the part of the common- 
wealth, then in its infancy. As an individual 
he sympathized with the project of opening the 
Mississippi River to free navigation, yet he 
held himself ready, not only to enforce the laws 
of Kentucky, but to perform whatever was 
constitutionally required of him, as Governor, 
by the President of the United States. His 
letter to General Washington is admirable in 
its tone, and exhibits more submission to the 
Federal authority than would now be shown by 
most Governors. His clear, far-seeing judg- 
ment predicted the downfall of slavery, and 
that a civil war would be inevitable to accom- 
plish that end. J 

Shortly after the close of the Revolutionary 
war he removed to Kentucky from Virginia, 
and preempted large tracts of land m the rich- 
est and most fertile portions of the State. He 
erected a substantial residence built entirely of 
gray granite. He soon had the forest cleared 



64 R & 7 URN FR OM EDINB UR GH. 

of its heavy undergrowth, and to make the sur- 
roundings of his home more attractive he spared 
from the axe an avenue of stately forest trees 
to guide the visitor to "Traveller's Rest," — 
an original name given by him to his homestead, 
a name suggestive of comfort and of rest to 
the weary pioneer, for at " Travellers' Rest" 
such were sure to find a welcome and a haven 
from the perils and dangers incident to the life 
of a frontiersman. The present generation 
can never fully realize the privations which our 
forefathers endured in order to civilize this glor- 
ious land — a country, as it has now become, that 
compares favorably with any other in surgery, 
science, and literature. 

It was at this historic homestead that the 
wise men of the land met and held counsel to 
devise means for the rapid civilizing of the 
country which was to be their future home. 

In recently viewing the broad fields of golden 
grain, the new-cut grass, the orchards of ripen- 
ing fruit, they all were suggestive of the pros- 
perity and cultivation of one of Kentucky's 
most famous farms — " Travellers' Rest," which 
is still in the possession of the Shelby family. 
The old rock house has stood the storms of 
more than a century, but the fierceness of 



/. 



RE TURN FR OM EDINB UR GH. 65 

Nature's devastating touch is not without its 
signs upon the vine-clad walls. 

It was at this home that Dr. Ephraim Mc- 
Dowell met, won, and wedded his wife, and it 
is in the family burying ground belonging to 
''Travellers' Rest" that both were interred. 

Several years previous to his death Dr. 
McDowell purchased a highly improved tract 
of land, with a modern-built, commodious 
dwelling upon it, situated about three miles 
from Danville. Here he removed with his 
family with a view to spending the remainder of 
his life in quiet, yet with no intention of giving 
up his lucrative practice, which had grown to be 
very extensive. The yearning of his heart 
however, was for a quiet rural home, where 
he and his family and friends might enjoy the 
comforts to be found in country living. 

When the footprints of civilization were un- 
known in Kentucky, and only savage war 
whoops resounded through the depths of the 
forest, there lived a brave Indian chief called 
"Cambiskenneth." Dr. McDowell was so much 
pleased with some of. the noble traits of char- 
acter possessed by this person that in honor of 
him he called his country seat "Cambisken- 
neth." A legend runs thus: Cambiskenneth 

5 




66 KE 7 URN FR OM EDIXB UR GH. 

was the chief of a tribe of savages that had 
committed many outrages on the early set- 
tlers. In their perambulations they captured 
a fair young maiden who had ventured too far 
from home, and bore her away to their village 
(a circumstance not at all unusual in those 
days). When they arrived at their destination, 
a violent controversy arose between the war- 
riors as to who was entitled to have the maiden 
for his wife. In the midst of their discussion 
the commanding form of Cambiskenneth ap- 
peared on the scene. He silenced them, by 
saving they had stolen the girl awav without 
his approbation or knowledge, and against his 
avowed principles, and commanded them to 
take her immediately home. Well they knew 
that when their chieftain gave an order it was 
to be obeyed. For this act of mercy the In- 
dian was ever afterward treated with the oreat- 

o 

est kindness and consideration by the settlers. 
Travellers in passing over "Muldrow's Hill" 
pause to look at a mound of considerable height 
bordered by a crude granite slab that marks the 
last resting-place of the brave and noble Cam- 
biskenneth. 

Although Dr. McDowell was a slave-owner, 
he recognized the negro as belong-ino- to the 



RETURN FROM EDINBURGH. 



6; 



4 



human race. His own slaves were treated 
with the utmost kindness and considera- 
tion by himself, and as well by his entire 
family. He was never known to traffic in 
slaves, but would frequently purchase a man 
or a woman if one had fancied and married a 
servant belonging- to himself. He would never 
under any consideration separate families. He 
evidently had a more tender feeling for the 
negro than had the renowned Dr. Johnson, 
who is reported as saying that a negress could 
"bear cutting about as well as could a dog or a 
rabbit." 

Dr. McDowell was a prayerful man, as an 
evidence of which we have the following invoca- 
tion offered up by him to the Divine Master a 
few hours before the appointed time to make the 
first "ovariotomy." He realized that his feeble 
hand, without the strengthening power of the 
Almighty Father, would prove futile in the try- 
ing experiment he was about to make. It was 
an event that was to render his name immortal, 
and be the means of saving countless numbers 
of lives ; otherwise, in case of failure of the 
operation, was to prove his destruction. 

It was truly a trying hour with him, and it 
as well that he sought his closet and in ear- 



68 RE TURN FR OM EDINB UR GH. 

nest prayer made an appeal to God to be with 
and help him. His abiding faith in the efficacy 
of prayer was beautiful, and no doubt his re- 
markable success in the field of surgery can 
be largely attributed to his strong convictions 
and unwavering faith in the Great Jehovah. 

Remembering the prayer and writing it down 
with his own fingers he placed it in his pocket, 
thinking some day that his faithful wife might 
accidentally find it — perhaps after his death, for 
threatening clouds were gathering about him 
as the time drew near for him to perform the 
operation upon Mrs. Crawford. 

THE PRAYER. 

" Almighty God be with me I humbly be- 
seech Thee, in this attendance in Thy holy 
hour ; give me becoming awe of Thy presence, 
grant me Thy direction and aid, I beseech 
Thee, that in confessing I may be humble and 
truly penitent in prayer, serious and devout in 
praises, grateful and sincere, and in hearing 
Thy word attentive, and willing and desirous 
to be instructed. Direct me, oh! God, in per- 
forming this operation, for I am but an instru- 
ment in Thy hands, and am but Thy servant, 
and if it is Thy will, oh! spare this poor afflicted 






RE TURN FR OM EDINB UR GH. fig 

woman. Oh! give me true faith in the atone- 
ment of Thy Son, Jesus Christ, or a love suffi- 
cient to procure Thy favor and blessing; that 
worshipping Thee in spirit and in truth my 
services may be accepted through his all-suffi- 
cient merit. Amen." 



i 



CHAPTER V. 

THE FIRST CASE OF OVARIOTOMY. 

It was on the thirteenth day of December, 
1809, when Dr, McDowell had been practis- 
ing his profession fourteen years, that he was 
sent for to see Mrs. Crawford, residing in 
Green County, Kentucky, some sixty miles from 
Danville, who was thought by her physicians 
to have gone long beyond her time in preg- 
nancy, and to be the subject of extra-uterine 
fcetation. McDowell found her trouble to be 
an ovarian tumor, rapidly hastening to a fatal 
termination. To quote the graphic description 
of Dr. Gross: "After a most thorough and 

o 

critical examination, Dr. McDowell informed 
his patient, a woman of unusual courage and 
strength of mind, that the only chance for 
relief was the removal of the diseased mass. 
He explained to her with great clearness and 
fidelity, the nature and hazard of the operation. 
He told her that he had never performed it, 
but that he was ready, if she were willing, to 
(70) 



FIRST CASE OF OVARIOTOMY. y z 

undertake it, and to risk his reputation on the 
issue, adding that it was an experiment, but 
one well worthy of trial." 

Mrs. Crawford listened to the surgeon with 
great patience and coolness, and at the close 
of the interview promptly assured him that she 
was not only willing, but ready to submit to his 
decision, asserting that any performance which 
held out even the most remote prospect of relief 
was preferable to the ceaseless agony she suf- 
fered. 

The result has long been before the profes- 
sion. 

McDowell was conscious at the time he 
was doing the operation, that an angry and 
excited crowd of men were collected in the 
street awaiting the result of his experiment 
of ''butchering a woman," as they expressed 
it. Had she died under the operation, there 
was no law in those primitive days sufficiently 
strong to have protected him from the people 
who were clamoring for his life — determined 
men who would have shown no mercy, for they 
regarded it a duty to avenge the wrong inflicted 
on Mrs. Crawford. Indeed his life hung on the 
recovery of the heroic woman. What nerve, what 
confidence in God and in his own ability, must 



j 2 FIRS T CA SE OF OVA RIO TOM Y. 

the surgeon have possessed to venture the per- 
formance of an operation of the magnitude of 
ovariotomy under such circumstances. No 
soothing balm to quiet the nerves of his 
patient; only a covering thrown over her pallid 
face to shut out from her view the flashing of 
the few instruments that he used. 

This signal event in the life of the illustrious 
surgeon cannot fail to impress a reader with 
the remarkable firmness of nerve and, as 
well, the surgical genius possessed by Dr. Mc- 
Dowell. It portrays strength in his character 
worthy of much more than a passing notice, 
and proves conclusively that the operative 
germ slumbered in his mind, waiting a proper 
subject. This subject came in the person of 
Mrs. Crawford. 

Dr. McDowell's close observation of manip- 
ulations practised on certain of the lower ani- 
mals, together with lasting impressions received 
from his old preceptor, generated, no doubt, 
the thought of his operation of ovariotomy, 
while consciousness of skill, and of dexterity in 
handling the scalpel, gave him confidence and 
courage in his own ability. With these was 
combined a firm conviction in the efficacy of 
prayer. 



FIRST CASE OF OVARIOTOMY. j-. 

As one of Chicago's most prominent sur- % 
geons remarked in speaking of the operation, 
"Your grandfather was the instrument and God 
the great surgeon that did the work." It really 
seems that there is much truth in these words, 
and, remembering all the attending circum- 
stances under which it was performed, that 
McDowell was inspired to do the operation — 
one hitherto unknown to the world. 

We regret our inability to procure a life 
picture of Mrs. Crawford, the famous first 
patient, but learn from a reliable person that 
she never had one taken. This same per- 
son gives us a graphic description of the 
appearance of the woman who so bravely 
gave to Dr. McDowell an opportunity to 
"experiment" upon her, and by which exper- 
iment her life was saved and he made im- 
mortal. She was above the medium height, 
and weighed, before her affliction, one hundred 
and sixty-five pounds. Her form was good, and 
her face impressed a beholder as representing 
character, determination of spirit, and large 
patience. Her eyes were of that full, gray kind 
which indicate firmness. Her forehead was 
overhung with clusters of wavy brown hair. 
She was not a handsome woman, her features 
being too prominent and large, and her lips too 



74 FIRST CASE OF OVARIOTOMY. 

firmly set and curling. For some years after 
the operation was performed upon her, she re- 
mained at her old home in Green County, 
Kentucky, but finally moved with her family to 
Indiana, where she lived until her death. 

So far as we have been able to ascertain, 
the degree of M : D. was not possessed by him 
until the year 1825, when, entirely unsolicited 
on his part, the University of Maryland honored 
itself by conferring upon him its honorary 
diploma. The Medical Society of Philadel- 
phia, at that time the oldest and most distin- 
guished of the kind in this country, had sent 
him its acknowledgment in the year 181 7. The 
following names are identical with those at- 
tached to the diploma presented him in 1825, 
by the University of Maryland : 

John P. Davidge, A.M., M.D., 

Professor of Anatomy. 

Nathaniel Potter, M.D., 

Professor of Theory and Practice of Medicine. 

Elisha DeButts, M.D., 

Professor of Chemistry. 

Samuel Baker, M.D., 

Professor of Materia Medica. 

Richard Wilmot Hall, M.D., 

Professor of Obstetrics. 

Maxwell McDowell, M.D., 

Proftssor of Institutes of Medicine. 

Granville Sharp Pattison, 

Professor of Surgery. 

James Kemp, D.D., 

Praefectus. 

Johannes Allen, 

Professor of Mathematics. 



FIX ST CASE OF OVARIOTOMY 



75 



Copy of the diploma awarded to Ephraim 
McDowell, by the University of Maryland, in 
the year 1825 : 

Academia Terrae Marias Omnibus ad quos hae literae per- 
venerint Solutem. Cum mos sit antiquus et laudabilis ut qui 
multolabore studioque assiduo Uteris operam navaverint ii 
insigni aliquo honoris titulo condecorentur cumque nobis 
compertum sit Dominum E. M. rerum Medicinalium et Phil- 
osophicarum scientia et usuperitissimum et omnino talem 
esse quern summi in Medicina honores deceant potius ultro 
ambiant ; Nos eundem doctissimum virum E. M. summo quo 
potuimus honore prosequi volentes Medicinae Doctorem rite 
et legitime creavimus, renuntiavimus, eique tanquam vere 
idoneo et optime merito omnia Jura, Honores et Privilegia 
contulimus quae Medicinae Doctori legibus aut consuetudine 
conceditribuique solent. In quorum fidem Uteris hisce sigillo 
Academiae communi munitis nomina nostra subscripsimus,, 
Datum Urbe Baltimoriensi Mensis. Aprilis die quarto Anno 
Domini MDCCCXXV. 

Jas. Kemp, D.D., Praefectus. 

Joannes B. Davidge, A.M., M.D., Art. Incid. Prof. 

Nath'l Potter, M.D.. Theoret. Med. et Prax. Prof. 

Eliska DeButts, M.D., Chem. Prof. 

Samuel Baker, M.D., Mat. Med. Prof. 

Rich'd Wilmot Hall, M.D., Obstetri. Prof. 

Maxwell McDowell, M.D., Inst. Med. Prof. 

Granville Sharp Pattison, Chir. Prof. 

Dr. McDowell certainly stood in his own 
light out of failure to report the numerous and 
skilful operations he performed, but at the 
same time many excuses are to be made for 



7 5 FIRST CASE OF OVARIOTOMY. 

him. The condition of the country, the times 
in which he lived, and his great aversion to 
writing, palliate the seeming neglect of what 
appears to have been his duty. He was so 
negligent as to corresponding that when absent 
from home he would seldom send a letter 
to his immediate family, unless emergency 
demanded it. From the fact of his not re- 
porting his minor operations they are lost 
to his credit. A prominent Brooklyn surgeon 
said that he knew from good authority that 
Dr. McDowell was the first to perform the 
Caesarean section in this country successfully, 
the operation being done in New York City. 
No report of the case was made. 

He was remarkably successful in general 
surgical work, and we have ascertained from 
authentic sources that he was the first to 
venture upon a partial excision of the inferior 
maxillary bone. Afterward Dr. Wood, of New 
York, perfected the operation and obtained the 
honor. Dr. McDowell was really the origina- 
tor of the performance, though, as usual, he 
made no public account of it. 

One of his (Dr. McDowell) most interesting 
cases, in consequence of the exalted position 
afterward attained by the patient, was that of 



FIRST CASE OF OVARIOTOMY. jy 

James K. Polk, President of the United States. 
This gentleman had suffered for years from 
symptoms of vesical calculus, and in 1812, 
when in his seventeenth year, he was induced 
to consult Dr. McDowell, at Danville. He 
carried the stone home with him, not in his 
bladder, but in his pocket, to show to his 
friends and neighbors. In a letter dated Maury 
County, West Tennessee, December 3d (which 
letter we have been unable to procure), he in- 
formed Dr. McDowell of the progress of his 
cure, and feelingly expressed his gratitude for 
the services which he had received from him. 
The bad orthography and worse grammar con- 
tained in this letter, could but be contrasted 
with the contents of one which he wrote to 
Dr. McDowell fourteen years afterward, when 
he represented Tennessee in the Congress of 
the United States. This second was written 
with accuracy and even eloquence. 

Mr. Polk says : 

"My Dear Dr.: I have been enabled to ob- 
tain an education, study the profession of law, 
and embark successfully in the practice ; have 
married a wife and permanently settled in 
Tennessee, and now occupy the station in 
which the good wishes of fellow citizens have 



7 3 FIRST CASE OF OVARIOTOMY. 

placed me. When I reflect, the contrast is 
imposing indeed, between the boy, the meagre 
boy, with pallid cheeks, oppressed and worn 
down with disease, when he first presented 
himself to your kind notice in Danville, nearly 
fourteen years ago, and the man of to-day in 
the full enjoyment of perfect health." 

And this greatest boon, "perfect health," 
which he was enjoying, he owed to Dr. Mc- 
Dowell. President Polk early in life was per- 
manently cured of a hernia by him. 

It is evident that Dr. McDowell was an ex- 
ceedingly cautious practitioner, always looking 
to the preparation of the patient's . system 
before going into an operation. His anatomi- 
cal knowledge, dexterity, and his courage were 
sufficient to enable him to execute any manipu- 
lation that might have been required within the 
circle of his extensive practice. He took espe- 
cial pains in aiding his pupils to acquire a 
knowledge of the human structure. 

Upon three different occasions he crossed 
the Atlantic Ocean to do the Caesarean section, 
and with the first two cases both mother and 
child lived. He never made report of these 
performances, and the members of his family J 
were the only persons that knew the object of 
his missions abroad. 



FIRST CASE OF OVARIOTOMY. yg 

He seemed in his surgical ambition, as he 
increased in years and confidence, to become 
lost in all-absorbing thought as to how to help 
suffering humanity. 

Some writer has wisely remarked, in vindica- 
tion of surgeons and men of the healing art 
who have borne the semblance of having been 
remiss in their reports of important cases or 
discoveries, that "in former times before the 
organization of the numerous medical vehicles 
and medical colleges and societies which now 
exist throughout the civilized land, and when a 
medical journal was almost unknown, there was 
an excuse for failure to bring one's original 
work and discoveries promptly before the medi- 
cal profession, as was the case with Ephraim Mc- 
Dowell, but now the facilities for communicat- 
ing being so general no excuse is to be made 
for the delinquent pioneer, for such are not with- 
out opportunities to inform the profession as 
to what they have done or are doing. Indeed 
they are even urged and importuned to do so 
by the enterprise of medical journalists, and 
the officers of medical societies. One who in 
this day locks up in his own bosom, and for 
years, the knowledge of a valuable discovery 
may well be asked if he has not forfeited all 



8 o F/AS T CA SE OF OVARIO TOM Y. 

claims under a statute of limitation, by reason 
of his neglect or of a desire to conceal." 

The reader must bear in mind that at the 
time McDowell lived and practised his pro- 
fession, there were even no stage coaches in 
use ; the only mode of transportation being by 
horseback, and journeys were often attended 
with great danger and much privation to the 
traveller. Fifty or one hundred miles was con- 
sidered no uncommon distance for a physician 
to be called to see a patient. Dr. McDowell 
was frequently so sent for, and it became 
necessary for him to take such long journeys, 
carrying his medicines and surgical instruments 
in " saddlebags," a manner of practice unknown 
to physicians of the present day. His earthly 
mission was, indeed, to relieve the sufferings of 
his fellow beings. 

On one occasion he was called to see a 
patient who lived over a hundred miles distant 
from his home. It w r as an important surgical 
operation that was required and which de- 
manded speedy attention, and although it was 
in a season of the year when the streams and 
brooks throughout the entire country were 
swollen beyond their utmost capacity, when 
little rivulets had become rushing creeks, and 



FIFS T CA SE OF O VA RIO TOM V. g z 

small brooks wide-spreading rivers, causing 
peril and danger to the traveller, he ven- 
tured upon his journey. His devoted wife, 
entreated him not to go — not to risk his life. 
But duty called him, and that summons must 
be obeyed. She hastily prepared the necessary 
articles for the trip, and with many misgiv- 
ings bade him farewell. He mounted his faith- 
ful horse that had borne him in safety on 
many a similar errand, and soon was lost to 
sight in the distance. After having ridden 
some forty miles he came to a stream of water 
overflowing its banks. For a moment he 
viewed the swollen current, meditating on what 
course to pursue, for the driftwood was dash- 
ing and driving with such force that he feared 
(should he attempt to cross) collision with it. 
There was no alternative, however, but to let 
his horse have the rein and swim the angry 
torrent, that seemed bidding defiance to the 
doctor and to his mission of mercy. 

He realized his danger in attempting to 
cross, but the beautiful Christian faith mani- 
fested itself to him, and a still, small voice 
whispered "Fear nothing, for I am with thee," 
and the next moment he threw the bridle 
over his horse's head, and with charac- 

6 



82 FIRST CASE OF OVARIOTOMY. 

teristic instinct the animal plunged into the 
surging water. At times the doctor stood in 
his stirrups trying to escape the debris that 
threatened destruction to both horse and rider. 
Finally a heavy saw-log came in contact with 
the horse, almost causing the struggling animal 
to drown, but with herculean strength he over- 
came the dangerous situation, and raising his 
head in the air and blowing the muddy water 
from his distended nostrils, swam with a des- 
perate effort safely to shore. The doctor 
arrived at his destination, performed the critical 
work successfully, and returned to his home 
thankful and happy. Our forefathers who 
selected the profession of medicine, certainly 
practised it under great difficulties. 

Is the restless spirit of man in this progres- 
sive age as content and happy, surrounded 
with all the modern luxuries, as were our fore- 
fathers in their primitive homes, free from 
ambitious pride, and desire to outlive their 
neighbors ? We think that we can answer this 
question through the peaceful family circle of 
Dr. McDowell. He could say as did the Apos- 
tle Paul : "I have learned in whatsoever state I 
am, therewith to be content," and therein lies 
the true state of happiness. This is to a great 



FIRST CASE OF OVARIOTOMY. g^ 

degree the secret of Dr. McDowell's mighty 
faith, and it is a secret all would do well to 
learn. 

His hospitality was proverbially known, and 
it was seldom that "Cambiskenneth" was with- 
out visitors. Mrs. McDowell being a model 
housewife, order and method prevailed. Her 
domestic discipline was perfect, and had, 
blended with it, kindness and consideration. 
It was a pleasure to be a guest in such a 
well-regulated household. 

Dr. McDowell's great benevolence was one 
of the marked characteristics of his nature, and 
much of his daily practice was gratis. The 
writer had the pleasure of meeting several very 
aged persons who remembered vividly the many 
cases which he had operated upon, without in 
a single instance making any charge. A poor 
woman from the mountains of Tennessee hear- 
ing of the doctor's wonderful skill, and feeling 
convinced that some dreadful affliction had be- 
fallen her, wrote him soliciting advice as to 
what to do. He replied, asking after symp- 
toms and everything connected with her case. 
She sent the required word, and he was con- 
vinced that she had an ovarian tumor ; not being 
satisfied with a seeming neglect to give her the 



84 FIRST CASE OF OVARIOTOMY. 

required professional assistance, he made a 
journey to see her. Her condition was found 
deplorable, as she was suffering from the 
disease inferred. He operated successfully 
upon her, making no charge ; his remuneration 
were these words : "God will bless you, doctor, 
for having saved my life.*' 



CHAPTER VI 



PERSECUTIONS. 



As Dr. McDowell ascended the ladder of 
fame persecutions went with him ; men in the 
profession, be it told to their dishonor, resorted 
to unprofessional acts, to traduce and injure the 
high standing and irreproachable character of 
the dauntless surgeon. Providence had, how- 
ever, spared the life of brave Mrs. Crawford, 
and by so doing ovariotomy was founded. 

It is a noted fact, and undisputed experience 
shows it, that the man of genius, the man 
destined to rise, must traverse the rank and 
foulsome sloughs of envious persecution, until 
.victory carries him out of them. Wisely said 
Professor Tyndale recently in speaking of the 
discouragements men of genius had to contend 
against: "A great theory has never been ac- 
cepted without opposition. Such must always 
be the course of things so long as men are 
endowed with different degrees of insight : 

where the mind of genius discerns the distant 

(85) 



S6 PERSECUTIONS. 

truth which it pursues, the mind not so gifted 
often sees nothing but the extravagance which 
it avoids." 

As an instance of a spirit of jealousy on the 
part of a member of the medical profession the 
following is to be noted. During- one of the 
occasional absences from home of Dr. Mc- 
Dowell, his wife had a slight indisposition. Dr. 
Hunn, a self-important, opinionated and aristo- 
cratic old man, living in Danville and not far 
from the residence of McDowell, was called in 
to see her. He diagnosed the case, and with 
characteristic malevolence, to be appreciated in 
the reading of a succeeding paragraph, at once 
declared her to be dangerously poisoned, but 
said that if the family would have a cow driven 
into the yard, so that he might have fresh milk 
whenever called for, he could save her. All was 
arranged as he directed, and in due course of 
time Mrs. McDowell recovered. Nature was 
the successful physician. 

It seems to be a false dignity, a mistaken 
notion of elevated character, that prompts the 
worthy and skilful physician to stand idly by 
and see the substantial rewards of his labor 
appropriated by shameless pretenders. There 
is such a sympathy between this class of indi- 



PERSECUTIONS. g* 

viduals and the people generally, that it would 
be but a just retribution should scientific physi- 
cians abandon the field, and leave the public 
entirely in the hands of the nostrum-venders 
and advertising charlatans, — at least for a gen- 
eration or two, or until men shall have learned 
to appreciate the true physician and his scien- 
tific acquirements, 

The Dr. Hunn alluded to above, in order to 
injure the social standing of McDowell, fabri- 
cated a wicked falsehood, reporting that Mrs. 
McDowell had been poisoned by a young 
medical student at that time in the office of 
her husband, and that this pale, interesting 
man of medicine was none other than a young 
lady, dressed in man's clothing. The assertion, 
malevolent lie as it was, found acceptance by 
some of the credulous, and not until after the 
marriage of the student, and he or she becom- 
ing a father, were their minds disabused of 
this wicked impression. We relate the incident 
as showing one of the many annoyances to 
which Dr. McDowell was subjected. It was 
only, however, when enemies assailed his pri- 
vate character that his indignation was aroused. 
He was a brave man, but one of such decision 
of character as to be master of his passions 



88 PERSECUTIONS. 

and will. He usually armed himself when 
called at night to visit a patient, especially in 
the country. He only feared the assassin, 
who " loves darkness rather than light." 

His persecutions were very annoying, and 
his own profession denounced him as a cruel, 
wicked person, who had no sympathy for man 
or woman — that he gloried in cutting open the 
belly of a woman. His most intimate profes- 
sional friends avoided him, and the prejudice 
was carried so far that he was socially shunned 
by many. The negroes of the village and the 
surrounding country being naturally ignorant 
and superstitious, whenever they spied Dr. 
McDowell walking in the distance, would rush 
into the nearest building, fearing that he might 
waylay and maltreat them. They feared him 
as they would some beast of prey. Indeed 
they could scarcely be induced to venture out 
after twilight, unless McDowell was absent 
from home. For this fear, their masters were, 
of course, responsible. 

But he had his sport out of them. One after- 
noon as he was wending his way homeward, he 
met, in a solitary part of the road, a burly negro 
face to face. The man looked an instant at 
the doctor, and then attempted to run, but being 



PERSECUTIONS. 3^ 

ordered, halted. With wild, staring eyes, and 
terrified face, the negro gave one unearthly 
groan and falling upon his knees offered up an 
appeal to God that would have touched a heart 
of stone. When he stopped praying, the doc- 
tor talked with him, trying to make the man 
understand his foolishness. The negro stated 
that he had heard his old master say, "That 
Dr. McDowell was next to the devil — that he 
went about cutting people open and killing 
them." To the time of his death, the ignorant 
residents, both white and black, held such ideas 
of him, and no argument could disabuse their 
minds of the uncanny impressions. 

Though his trials were many, they were dis- 
pelled by his abiding faith and by happy influ- 
ences related with his family circle. He taught 
his children, when engaged in sport, to regard 
him as one of themselves, dispossessing himself 
of that forbidding awe with which parents too 
frequently wean off their offspring. 

It is a remarkable fact that a man so true 
and sincere in his nature, as was Dr. McDowell, 
should have been a target for an envious pre- 
tender to hurl his venomous darts against. 

In reading the medical literature of the present 



QO PERSECUTIONS. 

age, we were chagrined at the unfairness meted 
out to Dr. McDowell by Mr. Lizars, who should 
have risen above such (to say the least of it) 
an unprofessional as well as dishonorable act, 
if the act were not due to negligence. True, 
Mr. Lizars is now numbered with the dead, and 
the thought may occur, let the faults of the 
dead be buried with them. Very well and just, 
but the deeply wronged McDowell likewise 
sleeps with the dead, and the injustice done 
him cries to be righted, and it is our privilege 
and duty to gather all the facts relating to him 
and his works. Our object is to place the illus- 
trious surgeon where he should be, and to state 
facts regarding this remarkable man. 

Professor William Tod Helmuth, a renowned 
surgeon, says that the national pride of every 
American physician is to find gratification "in 
pronouncing Ephraim McDowell 'The father of 
ovariotomy,' not of American ovariotomy, but of 
ovariotomy the world over, and especially of 
ovariotomy in Great Britain. I am urged to this 
decisive pronunciation, because the endeavor has 
constantly been made in England to deprive the 
American people of the honor which belongs to 
them in this regard." Then he says further, that 
in 1817, Dr. McDowell prepared a report of 



PERSE CUTIONS. g i 

his cases, and with justifiable pride sent a 
copy to his friend and former preceptor Mr. 
Bell, whose health had failed, and who was then 
travelling on the Continent. Mr. Lizars had 
charge of Bell's correspondence and practice, 
and failed to transmit the report to him. Seven 
years later Mr. Lizars brought them to light 
(Dr. Peaslee says they slumbered for seven 
years for some cause then unknown), and when 
he did so, they appeared as an appendix to a 
paper recording a case of his own, which proved 
to be not ovariotomy, but one simply of an 
accumulation of fat. Mr. Christopher Heath, 
F.R.C.S., thus spoke to his class: 

" Although ovariotomy was first performed 
by Dr. Ephraim McDowell, of Danville, Ken- 
tucky, who was a pupil of John Bell, the opera- 
tion of modern times has been entirely of Brit- 
ish cultivation. Mr. Lizars, of Edinburgh, was 
the first to attempt ovariotomy in this country, 
and by the long incision, i. e., from the umbili- 
cus to the pubes ; his example was followed by 
a few other surgeons and from time to time a 
success was obtained." Mr. Heath allowed 
himself to overlook, ignorantly or wittingly, 
Dr. McDowell's eight successful cases attend- 
ing thirteen operations. 



92 PERSECUTIONS. 

The facts are that had Mr. Lizars not read 
and studied Dr. McDowell's report he would 
never have attempted the operation^ and when 
he did make such attempt he mistook a lump 
of fat for an enlarged ovary ; examination 
showing both organs to be healthy. Notwith- 
standing this humiliating fact, Mr. Lizars again 
attempted the performance, but in two cases 
was unable to remove the tumors, and in the 
third case mistook a sub-peritoneal uterine 
fibroid for a cystoma ovaria. 

The learned professor of surgery goes 
on to say: "These facts are very well 
known to every gynecologist, and though 
still of interest to the general practitioner, 
would not have been mentioned here had 
it not been that effort has recently been 
made in England by one high in authority, to 
give priority in the performance of ovariotomy 
to a certain Robert Houstoun, of Glascow. In 
Mr. Lawson Tait's latest work, 1883, the en- 
deavor of the author to procure for Great Bri- 
tain precedence in the performance of this 
operation is so apparent and indeed so over- 
drawn that the animus is plainly perceptible." 

We find the case of Mr. Houstoun which 
Mr. Tait refers to, in the Philosophical Trans- 



PERSECUTIONS. 93 

actions: (From the year 1 719 to the year 
1 733)' Abridged and Disposed under General 
Heads, Vol. vii., pp. 541-546. published in 
1834. 

We refer the reader to Case XXVIII. therein 
reported, being- that of Margaret Millar : 

"In Aug. 1701. Margaret Millar, living 
not far from Glascow, informed me, that 
her Midwife, in her last Lying-in, at 45 
years old, having violently pulled away the 
Burthen, she was so very sensibly affected 
by a Pain, which then seized her in the left 
Side, between the Umbilicus and Groin, that 
she scarce ever had been free from it after, 
but that it had troubled her more, or less, dur- 
ing 13 Years together ; that for two Years past 
she had been extremely uneasy, her Belly grew 
very large, and a Difficulty of breathing in- 
creased continually upon her ; insomuch, that 
for the last six Months, she had breathed with 
the utmost Difficulty. That in all that Space of 
Time, she had scarce eat so much as would 
nourish a sucking Child ; and that for three 
Months together she had now been forced to 
lie constantly on her Back, not daring to move at 
all, to one side or other. This tumour was 
grown to so monstrous a Bulk, that it engrossed 



94 PERSECUTIONS. 

the whole left Side, from the Umbilicus to the 
Pubes, and stretched the Abdominal Muscles to 
so unequal a Degree, that I do not remember 
to have ever seen the like in the whole Course 
of my Practice. It drew towards a point. Her 
being so long confined to lie continually on her 
Back, having grievously excoriated her, added 
much to her Sufferings, which, with want of Rest 
and Appetite, had greatly wasted her. 

" I told her, that in order to effectually relieve 
her, I must lay open great part of her Belly, 
and remove the Cause of all that Swelling : She 
seemed not frightened, but heard me without 
Disorder, and pressed me to the Operation. I 
drew (I must confess) almost all my Confidence 
from her unexpected Resolution, so that with- 
out loss of Time I prepared what the Place 
would allow, and with an Imposthume Lancet, 
laid open about an inch ; but finding nothing 
issue, I enlarged it two Inches, and even then 
nothing came forth but a little thin yellowish 
Serum ; so I ventured to lay it open two Inches 
more. I was not a little startled, after so large 
an Aperture, to find it stopped only by a glu- 
tinous Substance. All my Difficulty was to 
remove it ; I tried my Probe, I endeavoured 
with my Fingers, but all was in vain ; it was so 



■H 



PERSECUTIONS. g$ 

slipper)^ that it eluded every Touch and the 
strongest Hold I could take. 

"I wanted in this Place almost everything 
necessary, but bethought myself of a very odd 
Instrument, yet as good as the best, because it 
answered the End proposed. I took a strong 
Firr-splinter, wrapped some loose Lint about 
the End of it, and thrust it into the Wound, and 
by turning and winding it, I drew out above two 
Yards in Length of a Substance thicker than 
any Gelly, or rather like Glue that is fresh made 
and hung out to dry; the Breadth of it was 
above ten Inches : This was followed by nine 
full Quarts of such Matter, as I have met with 
in Steatomatous and Atheromatous tumours, 
with several Hydatides of various Sizes, all con- 
taining a yellowish Serum, the least of them 
bigger than an Orange, with several large 
Pieces of Membranes, which seemed to be Parts 
of the distended Ovary. Then I squeezed out 
all I could, and stitched up the Wound in three 
Places, almost equi-distant : 

" I was obliged to make use of Lucatellus s 
Balsam, which was made by her Lady for the 
Use of the Poor ; with this Balsam I covered a 
Pledget, the whole Length of the Wound, and 
over that laid several Compresses, dipped in 



p6 persecutions. 

warm French Brandy, and, because I judged 
that the Parts might have lost their Spring by 
so vast and so long a Distention, I dipt in the 
same Brandy a large Napkin, four times folded, 
and applied it over all the Dressings, and with 
a couple of strong Towels, which were also 
dipt, I swathed her round the Body, and then 
gave her about four Ounces of the following 
Mixture : ^. — Aq. menthce, ft.ss. Aq. cinna- 
momi fort. Ibj.ss. Syr. Diacodii, Syj. — M. The 
Cinnamon Water was drawn off from Canary 
and the best Cinnamon ; indeed it was the 
finest and most fragrant Cinnamon Water I 
ever tasted : Of this Mixture I ordered her 2 
or 3 Spoonfuls 4 times a Day. 

"Next Morning I found her in a bathing 
Sweat, and she informed me, with great Tokens 
of Joy, that she had not slept so much, nor 
found herself so well refreshed at anytime for 
three Months past. 

"I carefully attended her once every Day, 
and as constantly dressed her Wound in the 
same manner as above, for about eight Days 
together : I kept in the lower Part of the 
Wound a small Tent, which discharged some 
Serosities at every Dressing for four or five 
Days. But Business calling me elsewhere, I 



PERSECUTIOXS. gy 

left her, having first instructed her two Daugh- 
ters how to dress her Wound, and told them 
what Diet I thought most proper. 

" Her chief Food was strone Broth made of 
an old Cock, in each Porringer of which was one 
Spoonful of Cinnamon Water ; this was re- 
peated 4 times a Day, and gave her new Life 
and Spirits. 

"After three Weeks Absence I called at her 
House, and finding it shut up, was a little sur- 
prised, but had not gone far before I was much 
more surprised, when I found her sitting 
wrapped up in Blankets, giving directions to 
some Labourers who were cutting down her 
Corn. 

"She mended apace, to the Admiration of 
everybody thereabouts, recovered surprisingly, 
and lived in perfect Health from that time, until 
October, 17 14', when she died in ten Days' 
Sickness. 

" That this Tumour, or rather Dropsy, of the 
Ovarium proceeded from the Midwife's Rash- 
ness in pulling away the Placenta, not knowing 
how to separate it from the Uterus skilfully, 
seems to me plain from what the Woman her- 
self told me, and what fell out afterwards. The 
Placenta adhering fast to the Uterus, required 

7 



p8 PERSECUTIONS. 

more Art to bring it away than she was Mis- 
tress of, which probably induced her to use 
Violence ; by which she forced down the Fundus 
Uteri ; so overstrained the Ligaments, and all 
that is appended to them ; especially the Liga- 
mentum latum of the left Side, and its Ovarium, 
which may be reasonably allowed to have been 
hurt in the Relaxation with the rest. Hence 
the Elasticity of these injured Parts was not 
only impaired, but the small Lymphatics rup- 
tured, so that the extra vasated Lympha rushing 
out, thickned, and not being able to recirculate, 
dilated the injured Ovarium, and thus increased 
the Tumour, and the Parts being already ex- 
cessively distended, and being no longer able 
to resist the new Influx of fresh Secretions rup- 
tured also, and by degrees augmented to that 
huge and enormous Bulk." 

Professor Helmuth, after citing excerpts from 
the above case, goes on to say: "I ask those 
who are in any way acquainted with the subject, 
can this be called an ovariotomy? Mr. Tait's 
reasoning on this subject is most peculiar ; he 
says: 'Although he (Houstoun) does not de- 
scribe his division of the pedicle, or his having 
tied it, it is almost certain that he did both. 
He certainly must have seen and divided the 






PERSECUTIONS. qq 

pedicle, for he describes the disease as being 
of the left ovary, therefore he saw the pedicle.' 
How the latter conclusion could be deduced 
from the former expression appears to me to 
be incredible. The disease was of the left 
ovary, 'therefore he saw the pedicle/ Mr. Tait 
further continues, 'perhaps he tore it and it did 
not need tying.' .... From a careful reading 
of all this, I think we may make deductions 
entirely antagonistic to those of Mr. Tait, and 
may positively say that Houstoun did not per- 
form a complete ovariotomy It has been 

suggested by Dr. R. S. Sutton, 1 of Pittsburgh, 
that Dr. Houstoun, without knowing, enucle- 
ated the cyst and directed no further attention 
to the pedicle. Peaslee 2 simply says, ' Dr. Hous- 
toun did not perform ovariotomy.' .... With 
the careful understanding of all these circum- 
stances, we hope that it must be apparent to 
every one that Dr. McDowell still holds priority 
of claim in the performance of this operation, 
and we must still dignify him with the title of 
' The Father of Ovariotomy?" 

1 A paper read at the meeting of the American Gynecological 
Society, held in Boston, 1882. 

2 Ovarian Tumors, p. 227. 



CHAPTER VII. 

DEATH OF DR. EPHRAIM MCDOWELL. 

In the year 1830, on the evening- of the 20th 
of June, while almost in the prime of life, Dr. 
Ephraim McDowell passed from earthly scenes, 
peacefully yielding up his useful and well-spent 
life. The physicians in attendance on him pro- 
nounced the cause of dissolution an acute attack 
of inflammation of the stomach. His illness, 
which was very brief, was caused by eating 
strawberries. It was a habit with him, when 
the fruit was in season, to go into his garden 
and gather the berries fresh from the vine, and 
to eat of them freely. On this occasion he 
gathered and ate a good many, as they were 
unusually fine in flavor and sweetness. When 
he returned to the house he was ill, and com- 
plained of great pain with nausea. 

Mrs. McDowell at once dispatched a servant 
for the family physician, who shortly arrived, 
and seeing the critical and dangerous condition 
of his patient desired a fellow-practitioner to be 
summoned with view to consultation. 

( 100) •*•, ; 



DEA TH OF EPHRAIM MCDO WELL. j 1 

The case was diagnosed and treated as in- 
flammation of the stomach, but Dr. McDowell, 
agreeing with his wife's impressions, told them 
he thought he had eaten a poisonous insect or 
poisonous eggs that had been deposited upon 
the berry. The physicians, however, did not 
agree with the suggestion made, but treated 
the case in accordance with their diagnosis. 
The patient was suffering too much pain to 
suggest anything that might have a tendency 
to relieve him, and in a short time, after acute 
suffering, he expired, surrounded by all the 
members of his family. His death occurred 
toward the close of the evening, and it was one 
of the most heavenly of all midsummer twilights 
— fanned as it was by zephyr breezes, the spirit 
of this good man passed to the God that had 
created it. 

Dr. McDowell was greatly respected in life 
by those who were able to appreciate his many 
praiseworthy qualities, and he filled an honored 
grave. His shortcomings were few while his 
merits were many, and we are to cover gently 
with the i( mantle of charity" his few faults, 
knowing as we do, his many virtues, and that 
these, like a running brook, "will live on and 
on forever," until the remembrances of him 



! 02 £>£A TH OF E PUR AIM MC D WELL 

and his works shall swell and grow like the 
mighty ocean. 

Could the countless number of women who, 
directly or indirectly, have been relieved from 
suffering and saved from an untimely grave 
through the benefaction of the Kentucky sur- 
geon, proclaim with one voice " McDowell was 
my salvation," the mighty echo would sound 
and resound from pole to pole. 

The brightest consolation that could be 
offered to his bereaved and heartbroken family 
over his untimely death was the assurance that 
his earthly career had been such that when the 
summons came to him that his spirit presence 
was desired to appear before the Divine Master, 
that he had a mission in the heavenly land to 
fill, he was ready to meet it. He died believ- 
ing firmly in the atonement of the blood of the 
lamb, the resurrection of the body, (and to the 
righteous) life everlasting. . 

Although at times his bark of life may have 
been tossed upon the tempestuous waves of 
oppression, and his spirit sorely tried, yet he 
was never known to take the name of God in 
vain. It does seem that his heart was made 
perfect ; tried in the crucible of affliction. 
When he was advised by his physicians that if 



DEA TH OF EPHRAIM MC D O WELL. lQ <, 

he had any business affairs to arrange, he had 
better attend to the matter before it was too 
late, he quietly said, with that calm Christian 
resignation so characteristic of the closing 
hours of the righteous believer, " All my earthly 
affairs are satisfactorily arranged, and, what is 
of more importance than all else, my peace with 
God is made, and in making that mysterious 
change from mortal to immortal I have no dread, 
for I can truthfully say, ' though I walk through 
the valley of the shadow of death I will fear no 
evil, for Thy rod and Thy staff they comfort 
me,' and I feel in parting with my beloved 
family and friends that my life has been devoted 
to their cause, that it has been the cherished 
object of my life to relieve suffering humanity; 
and I close my eyes in death forgiving those 
who have done me any injustice, and with the 
happy and peaceful assurance of soon being 
with Him who has ever guided my earthly pil- 
grimage, who forgiveth— " Before he could 
finish the sentence death had silenced his lips 
forever. 

A great and noble man had fallen — but not 
to be forgotten. His remains were interred 
in the family burying ground at ''Travellers 
Rest" (the homestead of Gov. Isaac Shelby). 
There they rested several decades undisturbed. 




I0 4 DEA Tn OF EPHRAIM MCDOWELL. 

He left his family comfortably provided for ; 
but had he possessed any mercenary qualities 
he could have amassed a large fortune. It was 
contrary to his nature, however, to " save up." 
His acts and sentiments of pure philanthropy 
and generosity were too extensive to have per- 
mitted any great accumulation of worldly pos- 
sessions, though his practice was extensive and, 
we might add, lucrative. He was an especial 
friend to the needy and oppressed, and his 
many acts of benevolence naturally diminished 
his income. 

Instead of avoiding, he sought out objects of 
charity, and was frequently known to go on 
missions of mercy during the night, and 
to travel several miles to see a sick patient 
when he had any doubts about a case, know- 
ing at the time that he could never realize, 
in the way of his purse, anything for his profes- 
sional services. But the desire and feeling to 
do good were innate with him; emanating 
from the noble impulses of a just and upright 
man, who was utterly void of selfish motives. 

What property he left was judiciously dis- 
posed of in a brief will. He bequeathed his 
beautiful homestead to his only son, retaining 
a life-interest in it for his wife. His daughters 
were provided for equally with the son. 



DEA TH OE EPHRAIM A1CD0 WELL. \ 05 

Mrs. McDowell realizing her utter desolation 
in the great bereavement experienced in the 
death of her husband, and not wishing to incur 
the responsibility of "farming," removed to 
Danville. Depressed by a sense of loneliness 
(for his place could never be filled) she decided 
to spend the remaining days of her declining life 
with her daughter, Mrs. Anderson, who was 
ardently attached to her mother. 

It was at the home of Mrs. Anderson, ten 
years after the death of her husband, that Mrs. 
McDowell passed away. Her death was deeply 
regretted. She had carried on the charitable 
work which her lamented husband had inaugu- 
rated so many years previously, and her death 
fell heavily upon that class of people who were 
recipients of her goodness. She fully seconded 
the purposes of her deceased husband, for no 
one ever heard either him or her say to the 
needy and destitute "be ye warmed and be ye 
clothed," without at the same time seeing fur- 
nished by them needed means for relief of 
the necessities. 

The remains of the wife were placed beside 

those of her husband, in the family burying 

ground six miles from Danville. There both 

jodies remained undisturbed until the year 



! 6 DEA TH 0F EPHRAIM MCDO WELL. 

1879, when that of Dr. McDowell was removed 
to Danville and reinterred in the place desig- 
nated by the Monumental Committee, which 
spot was appropriately selected near the monu- 
ment erected to his memory by the Medical 
Association of Kentucky. A question then 
arose (causing considerable controversy) re- 
garding the propriety of removing Mrs. Mc- 
Dowell's remains and placing them beside 
those of her husband. Was it right to separate, 
even in death, the persons of husband and 
wife ? The bodies had rested many years side 
by side. Should this not continue ? To take 
a benign view of the question, one can but be 
impressed with the solemnity of the position. 
The physicians met in council and decided to 
refer the matter to Dr. J. N. Toner, of 
Washington City. Dr. Toner having read and 
remembered the controversy, together with the 
decision rendered at the time of the reinter- 
ment of the remains of Mrs. Washington, the 
trouble the Committee had to procure the 
consent of the authorities in power at that 
time to place the remains of Mrs. Washing- 
ton beside those of her distinguished husband 
at Mount Vernon, he took the same stand 
in the question referred to him that the 






oa 



DEA TH OF EPHRAIM MCDO WELL. j Q j 

Committee did at the time of the removal of 
the remains of the President's wife. Conse- 
quently he was not long in deciding that it 
was proper and in accord with an instinctive 
sentiment, that Mrs. McDowell's body should 
be placed beside that of her husband. This 
decision was accepted and immediately acted 
on, and the wife now rests in the " McDowell 
Monumental Grounds. " Two conspicuous 
green mounds, placed side by side to the 
right of the shaft, mark the places of interment. 
All credit is due Dr. Toner for his wise and 
humane decision. 



CHAPTER VIII. 

CRITICISMS AND COMMENTS. 

Addenda in the shape of criticisms and 
comments relative to Dr. McDowell, his opera- 
tions and times, will hardly lack interest to 
the enlightened and less-selfish physician of 
the present age : criticisms on the then mur- 
derous ovariotomy, and bitter sarcasm hurled 
at "the father of ovariotomy." For most of 
these items we are indebted to reliable and 
prominent European and American surgeons. 

Dr. Ezra Michener, of Philadelphia, in an 
article in the journal 1 containing Dr. McDowell's 
reports, after saying, "It is much to be regretted 
that cases so interesting to the community as 
those of Dr. McDowell, and as novel as inter- 
esting, should come before the public in such 
a manner as to frustrate the intention of becom- 
ing useful," and expressing a hope that they 
really are "correctly stated," sarcastically quotes 
what is said in the report of the first case 
respecting the effects of the horn of the side- 
eclectic Repertory, Jan., 1818, vol. viii., No. 22, p. 114. 
(108) 



CRITICISMS AND COMMENTS. 



IO9 



saddle, and the patient being engaged in 
making her bed on the fifth day, and closes 
thus: "The utter impossibility of our ever 
being able to ascertain, with certainty, the real 
nature of those internal diseases, the delusive 
nature of all their indications, and the necessary 
danger of an operation under the most favorable 
circumstances, will be likely to prove an insur- 
mountable barrier to the use of the knife in 
their removal, as few persons will be likely to 
risk their reputation on such uncertain data." 

Dr. Washington L. Atlee, in referring to the 
early history of ovariotomy, 1 says : In 1853 
Joshua B. Flint, M.D., of Louisville, Professor 
of Surgery in the Kentucky School of Medicine, 
presented a report on Surgery to the State 
Medical Society, in which he outraged pro- 
fessional ethics in his opposition to ovarioto- 
mists .... unjustly denouncing McDowell. 

"It is well known that, from the earliest 
period of ovariotomy in Philadelphia down to 
the present time, it has been my invariable 
custom to invite members of the profession 
to witness the operation in order that they 

1 Annual Address before the Philadelphia County Medical 
Society, delivered February i, 1875. (Bound in Diseases and 
Surgery of the Uterus and Ovaries, No. 4, 1103, Library of 
Philadelphia College of Physicians.) 



no 



CRITICISMS AND COMMENTS. 



might be able to form a proper opinion of its 
character and to judge of its propriety. 

" There was not a prominent medical gentle- 
man in this city that had not such an oppor- 
tunity. It was a rare circumstance during the 
probationary stage of the operation for any one 
to accept the invitation cordially and gratefully. 
Others positively refused and emphatically con- 
demned the innovation, while others took the 
invitation as an insult. 

''Gentlemen who were bold enough to witness 
the manipulations were even directly accused 
by their professional acquaintances of being 
'particeps criminis' in committing murder ; not- 
withstanding, these murdered patients recov- 
ered. Some, high in the profession, against all 
ethical considerations, would call upon patients 
who had fully decided upon the operation, for 
the purpose of warning them against me and 
certain death. 

"The day before I operated upon my first 
patient in Philadelphia an eminent surgeon 
called upon her, to assure her that she would 
certainly be dead in twenty-four hours. 
Twenty-four hours after the operation I re- 
quested him to see her, and the condition 
was such that he would not believe she 



CRITICISMS AND COMMENTS. 



Ill 



had been meddled with until I exposed the 
wound. 

"The colleges, as stated, proclaimed fiercely 
against the operation as unjustifiable and crim- 
inal. Sometimes the professors would go out 
of their way to denounce it. One eminent 
surgeon, now dead, after the occurrence of a 
fatal case in 1851, opened his lecture on sur- 
gery in words like these : ' Gentlemen, it is 
my painful duty to announce to you that a re- 
spectable lady who, a few days ago, came from 
New York to this city with an ovarian tumor, 
which was removed by Dr. Atlee, returned to 
that city to-day a corpse.' This was particu- 
larly marked, as it had no relation to the sub- 
ject of that lecture. It was not uncommon for 
medical men to refuse to meet me in consulta- 
tion, for no other reason than my persistence 
in performing ovariotomy. 

"A prominent surgeon, then belonging to the 
staff of the Pennsylvania Hospital, upon being 
called out at night to see one of my patients, 
when I was sick in bed, after prescribing and 
without his having been solicited to join in the 
treatment of the case, voluntarily said, 'Tell 
Dr. Atlee that I will not meet him in consulta- 
tion, because he undertakes to perform opera- 



II2 CRITICISMS AND COMMENTS. 

tions not recognized by the profession.' An- 
other, in passing along Arch Street, opposite 
my house, in company with others, exclaimed, 
'There lives the greatest quack in Philadelphia.' 
And yet this same gentleman is now an ova- 
riotomist himself. Even my own colleagues, 
with the exception of Professor Grant, discoun- 
tenanced the operation, and endeavored to con- 
vince me of my error. 

"I need not dwell any longer on these early 
phases of the history of ovariotomy. Ovari- 
otomy, both privately and publicly, was de- 
nounced without measure, and the weight of 
the battle axe in this city fell upon my shoul- 
ders." 

Dr. Atlee says : " I commenced studying the 
literature of the operation, and soon realized 
the bold and important step taken thirty-four 
years before by Dr. McDowell, of Kentucky. 

"In speaking of Dr. Clay, of Manchester, Dr. 
Bird, of London, and Dr. Washington L. Atlee, 
of our own country, Dr. Flint says: 'It is cer- 
tain that neither of them has attained to the 
position of an authority in the commonwealth 
of surgery, and the force of their testimony to 
the propriety and value of the operation (ova- 
riotomy) is, moreover, very much impaired by 



CRITICISMS AND COMMENTS. x l 3 

the suspicious attitude in which they stand to 
it in having made it a sort of specialty, than 
which nothing is more trying to professional 
integrity. ' 

"The same opposition, although not so acrid 
and determined, assailed the operation and its 
advocates in other countries. In an innovation 
so momentous, this, perhaps, was best. For 
my own part I was and am satisfied. I believe 
my opponents were honest in their convictions. 
I know that I was, and as my actions were 
based upon abundant study of the subject in 
all its aspects, upon repeated facts constantly 
recurring, and upon the success attending those 
who practised ovariotomy, I felt assured that 
this great battle must terminate in favor of 
science and humanity." 

These extracts from Dr. Atlee show the un- 
merited opprobrium visited upon those who 
had the boldness and the temerity to perform 
ovariotomy. The struggle against professional 
prejudice was hard, and verifies the words of 
Bacon: "If a man perform that which hath not 
been attempted before, or attempted and given 
over, or hath been achieved but not with so 
good circumstances, he shall purchase more 
honor than by affecting a matter of greater 



H4 



CRITICISMS AND COMMENTS. 



difficulty, or virtue, wherein he is but a fol- 
lower." 

Dr. Charles D. Meigs, Professor of Obstet- 
rics, etc, in the Jefferson Medical College of 
Philadelphia, denounced McDowell in the bit- 
terest terms, and, in the presence of a number 
of medical students, boldly asserted that there 
was not a word of truth in what McDowell had 
reported in the Eclectic Repertory, A young 
student from Danville, was present when 
Dr. Meigs made these remarks, and a 
few days afterward meeting Dr. John L. Atlee, 
told him that Dr. Meigs was entirely wrong 
in what he had said and very unjust in the 
denunciation of Dr. McDowell and his abdomi- 
nal operation ; for he had frequently heard his 
father say that Dr. McDowell certainly per- 
formed ovariotomy successfully ; and it was fur- 
thermore true that McDowell did all he claimed 
in the surgical line, and that his reports were 
true. No man in the community, save the 
prejudiced and ignorant, he said, where Dr. 
Ephraim McDowell resided would ever ques- 
tion his veracity, for both the acts and life of 
the man were above reproach. No citizen, he 
added, was more respected for his truthful 
candor and conscientious principles. 



CRITICISMS AND COMMENTS. \ \ 5 

Dr. Atlee listened attentively to all that 
the student had to say in defence of Dr. 
McDowell. A few weeks afterward, being 
called to see a patient who had an ovarian 
tumor, he was led to ask himself why he, Dr. 
Atlee, could not repeat what he accepted as 
having been done by Dr. McDowell? The 
thought suggested to his mind was that 
"here was his opportunity," and after reading 
carefully the report of Dr. McDowell's cases 
he concluded to make the operation upon his 
patient, which he did with happy results. The 
lady recovered, and " ovariotomy" was again 
and again performed by Drs. Washington L. 
and John L. Atlee with remarkable success. 

In a treatise on Diseases of Women by Lawson 
Tait, F.R.C.S., published in 1879, the seventh 
chapter is devoted to a consideration of the 
ovaries, Of course, all forms of disease then 
known in these organs are described. A 
number of ovariotomies are detailed, done not 
only by the author of this book, but by a large 
number of others who have reported on the 
subject. A careful reading of the text fails to 
disclose even the name of Ephraim McDowell, 
to whose genius the world now accords all the 
blessings brought to humanity by ovariotomy. 



I x 6 criticisms and comments. 

In the fourth edition of Mr. Tait's work, 
Diseases of the Ovaries, published in 1883, com- 
mencing on page 242, speaking of William 
Hunter and his brother John, and also of 
Houstoun, the author says : " Their friend John 
Bell, who practised in Edinburgh from 1 790 till 
18 1 6, also pronounced in favor of its perform- 
ance, but he is not known to have done anything 
toward trying it himself, and it is to a young 
Scotchman, 1 who was a pupil of John Bell's in 
1793, that we owe the revival of the operation 
and its performance upon a scale which amount- 
ed to that of a legitimate experiment. Ephraim 
McDowell has been honored by the medical 
profession in America as the 'Father of Ovari- 
otomy,' and, whether we admit the accuracy of 
the title or not, there can be no doubt that it 
was in the backwoods of Kentucky that abdom- 
inal surgery received one of its greatest im- 
pulses. 

"In 1809," says Mr. Tait, "the second ovari- 
otomy was performed successfully, and the 
patient survived it thirty- two years. In 181 7 
Dr. McDowell published an account of this 

1 "My American readers may object that McDowell was not 
born in Scotland. Of this, however, we are not yet clear. At 
any rate, his father and mother were Scotch, and, at the time of 
his birth, 177 1, the States did not exist." 



CRITICISMS AND COMMENTS. 1 1 y 

and of two other cases he had performed, and, 
as might be expected, his statements were 
received with general incredulity 

"For some ten or twelve years after the death 
of Dr. McDowell, and after the failures of 
Lizars, ovariotomy seems, by common consent, 
to have been discontinued. 

"In March [May 8 X \ 1836, Dr. Jeaffreson, 
of Framlingham, removed a parovarian tumor 
successfully 

"In 1838, Mr. Crisp, of Harleston, and Mr. 
West, 2 of Tunbridge \_Nov ember 2, tSj/ 3 '], also 
had successful cases, but they were clearly all 
parovarian and not ovarian tumors 

"On September 27 \_i2tfa\ 1842, Dr. 
Charles Clay, of Manchester, who may in all 
truth be regarded as the 'Father of Ovariotomy ' 
as far as Europe is concerned, performed his 
first operation for the removal of a diseased 
ovary [The italics are ours, M. Y. R.] 

"Previous to September, 1842, we have, 
therefore, records of only two ovariotomies, 
properly so-called, in this country — those of 
Houstoun and Lizars 

1 Trans. Prov. Med. and Surg. Assoc, 1837, vol. v., p. 239. 

2 Lancet, Jan. 1837-38 3 Ibid. 1837-38, vol. i., p. 307. 

4 British Record of Obstetric Medicine, vol. i., p. 179, et seq., 
and Medico-Chirurgical Review, October, 1843. 



1 1 8 CRITICISMS AND COMMENTS. 

"Looking back upon the work of a genera- 
tion now almost passed, from a standpoint 
altogether free from personal bias, I have no 
hesitation, whatever, in ascribing to Dr. Clay by 
far the larger share of the credit which arises 
from the enormous advances made in ab- 
dominal surgery during the last forty years. 

"It is quite true that McDowell was the first 
to do a number of ovariotomies, and it is 
equally true that Houstoun was the first 
successfully to remove a diseased ovary, but it 
was Clay, of Manchester, who first showed that 
ovariotomy could be made an operation more 
justifiable by its results than any of the major 
operations of surgery." .... 

In conceding to Mr. Tait the last word on 
the subject, it will not be unfair to refer to his 
inconsistency in admitting that "McDowell was 
the first to do a number of ovariotomies " — 
[first operation, December ij, i8og\ claiming 
him as a "young Scotchman," etc, and then 
classifying Houstoun's removal of a " diseased 
ovary" \_August, 170 1~\, as an ovariotomy — 
"properly so-called," so as to establish Hous- 
toun as the first ovariotomist. 

Mr. Tait's argument in favor of Dr. Mc- 
Dowell's Scotch birth is predicated upon 



CRITICISMS AND COMMENTS. 119 

the fact that the United States did not exist in 
1 77 1. It might be well to mention, however, 
that the territory now known as the " United 
States" constituted an exceedingly firm and 
substantial portion of that terra firma known 
as the North American continent, even prior to 
that year, and that McDowell had originated an 
exceedingly important and praiseworthy surgi- 
cal procedure might easily be inferred by even 
the readers of Mr. Tait's voluminous writings, 
from the fact that Mr. Tait himself makes his 
proudest boast upon his superior success in 
the performance of the same work that Dr. 
McDowell gave to the surgical profession. 

We are to be permitted to correct a state- 
ment made by Mr. Tait. Dr. Ephraim Mc- 
Dowell's parents were not born in Scotland. 
His father, Judge Samuel McDowell, first saw 
the light in Pennsylvania, while his mother, 
Mary McClung, was a native of Ireland. 

Mr. Tait does not seem to have been cor- 
rectly informed regarding several facts relat- 
ing to Ephraim McDowell, otherwise he has 
allowed his prejudices to run away with truth 
and justice. But we are to say this much, had 
Dr. McDowell not opened the abdomen Mr. 
Tait's ''laparotomy" might yet be slumbering. 



I2 CRITICISMS AXD COMMENTS. 

In a valuable work entitled Ovarian Tumors, 
by E. Randolph Peaslee, M.D., LL.D., pub- 
lished in 1872, will be found, in Part II., com- 
mencing on page 225, a history of ovariotomy, 
from which the following excerpts are made. 
[The italics are ours, M. Y. R.] 

In the United States : "Dr. Alban G. Smith, 
who was, also, a practitioner at Danville \Ken- 
tucky\, and assisted Dr. McDowell, states that 
the latter performed ovariotomy thirteen times, 
in all, and that eight, at least, of these opera- 
tions were sucessful. [_Dr. Ephraim McDowells 
first operatio7i was on December zj, iSooi] 

"The next ovariotomist in this country, after 
Dr. McDowell, was Dr. Nathan Smith, then 
Professor of Surgery in Yale College, New 

Haven, Connecticut This operation 

"was performed at Norwich, Vermont, on the 
5th of July, 1821. 1 ..... 

"The third successful ovariotomist in this 
country was Dr. Alban G. Smith, of Danville, 
Kentucky, whom I have already mentioned in 
connection with the operations of Dr. E. Mc- 
Dowell. EI is operation was performed May 
23 [or 24*], 1823 

1 American Journal of Medical Sciences, April, 1851, and 
Edin. Med. and Surg. Journ., October, 1822, vol. xviii., p. 532. 

2 North American Med. and Surg. Journ., 1826, vol. i., p. 30. 



CRITICISMS AXD COMMENTS. I2 i 

"The fourth who attempted ovariotomy in 
this country was Dr. Joseph A. Gallup, Pro- 
fessor in the Medical College at Woodstock, 
Vermont. This operation was performed June 

12, 1S24. 1 .... 

"In April \_20~\, 1827, Dr. Trowbridge, of 
New York, attempted ovariotomy, but desisted 
on account of adhesions. 2 .... 

"In July, 1828, Dr. R. D. Mussey, Professor 
of Surgery in the Medical Department of 
Dartmouth College, attempted ovariotomy at 
Ryegate, Vermont. 3 .... 

" Dr. J. Bellinger, of Charleston, South Caro- 
lina, also attempted ovariotomy in 1828 

"The fourth who actually performed ovari- 
otomy in the United States, was Dr. David L. 
Rogers, still residing in New York, where his 
operation was performed September 24* [or 
//], 1.829 

" Dr. J. C. Warren, Professor of Surgery, 
Boston, attempted ovariotomy in November, 
1830. 6 .... 



1 New England Journ. of Med. and Surg., Oct., 1825, p. 358. 

2 Boston Medical Intelligencer, 1827, vol. v., p. 337. 

3 American Journ. of Med. Sciences, 1837, vol. xxi., p. 380. 

4 New York Med. and Physical Journal, 1830, vol. ii., p. 284. 

5 London Medical Gazette, 1829, 

6 Warren on Tumors, p. 589. 



122 



CRITICISMS AND COMMENTS. 



"In December [<?j], 1835, Dr. J. Bellinger, 
successfully performed the operation of ovari- 
otomy. 1 .... From that time there was no 
case of ovariotomy, in this country, until the 
year 1843, when Dr. A. Dunlap and Dr. J. L. 
Atlee had their first cases, the former an un- 
successful one. 

"Thus it appears that ovariotomy in this 
country, originating here in 1809, remained 
exclusively in the hands of its originator \_Dr. 

Ephraim McDoweW\ till 182 1 From 

this time to 1843, though several times at- 
tempted, it was actually accomplished only by 
Dr. Nathan Smith, Dr. A. G. Smith (who had 
previously assisted Dr. McDowell), Dr. Rogers, 
and Dr. Bellinger. 

" In 1843 an d I 844, a new impulse was given 
by the success of Dr. J. L. Atlee, and which 
was still further aided by his brother, Dr. W. 
L. Atlee 

For the history of ovariotomy, in the United 
States, subsequent to 1843, the reader is refer- 
red to the work from which above excerpts are 
taken, and to Dr. Peaslee's tables of statistics, 
pages 247, 248, wherein he remarks : " But few 

1 Southern Journal of Medicine and Pharmacy, May, 1847, 
vol. ii., p. 241. 



CRITICISMS AXD COMMENTS. i 2 $ 

cases of ovariotomy have been reported by 
these who have operated most frequently. 
.... But, from direct correspondence, I am 
able to supply the deficiency, to a great extent, 

in the statistics for this country This 

gives a total of six hundred and sixty opera- 
tions, and four hundred and fifty-three successes, 
or 68.63 per cent. .... Or, a total up to Octo- 
ber 10, 1 87 1, for this country \United States], 
of seven hundred and thirty-nine ovariotomies. " 

In Canada (West): "ovariotomy was per- 
formed, for the first time, in i860, by Dr. 
Reginald Henwood, of Brentford. The opera- 
tion was successful." 1 . . . . 

In Scotland: Mr. Lizars attempted his first 
case in ovariotomy \_October 23, 1823*"] 

"His subsequent operations were on Feb- 
ruary 27, March 22, and April 24, 1825. 3 

"After the experience of Mr. Lizars, ovari- 
otomy was entirely discountenanced in Scotland, 
and was not repeated for twenty years ; and 
then, in 1845 {September f\, by Dr. Handyside, 
of Edinburgh. For thirty-seven years, or up 
to 1862, it had been very seldom attempted in 

1 American Journ. of Med. Sciences, April, 1861, p. 575. 

2 Edin. Med. and Surg. Journ., Oct., 1824, vol. xxii., p. 247. 

3 Reported on pages 152 and 399-405 of this book. 



124 CRITICISMS AND COMMENTS. 

that country; and had succeeded only in a 
single instance. 1 

"In Ireland, also, it had been performed but 
three times up to April, 1862 ; and always with 
a fatal result." 2 

In England: "Dr. Granville, of London, twice 
attempted ovariotomy, in 1826 \July /] and 
1827 \_March 2i~\. The last of these two 
cases proved to be a uterine tumor, and the 
other was abandoned on account of adhesions. 3 

"In England no attempt at ovariotomy had 
ever been made, except these two failures of 
Dr. Granville, till May [£], 1836, when it was 
successfully performed by Mr. William Jeaffre- 
son, of Framlingham, for the first time in that 
country. 4 In this year two other successful 
operations were performed, by Mr. King \_July 
12, i8j6 5 ~\, and Mr. West \_November 2, i8jf\. 
In 1838, there was one successful operation by 
Mr. Crisp; and, in 1839, another by Mr. West, 
who, also, had one failure this year — this last 



1 The Lancet, January, 1863, p. 70. 

2 American Journ. of Med. Sciences, January, 1863, p. 239. 

3 London Medical Gazette, February 3, 1843, vol. xxxi., p. 672. 

4 Trans. Prov. Med. and Surg. Asso., 1837, vol. v., p. 239. 

5 Op. cit., January, 1837. 

6 Lancet, 1837-38, vol. i., p. 307. 



CRITICISMS AXD COMMEXTS. 



125 



being the first attempt at ovariotomy in a 
London Hospital. 

"In September [9], 1840, ovariotomy was first 
completed in a London Hospital, by Mr. Ben- 
jamin Phillips, but the patient died. 1 

"On November 6, 1842, Mr. D. H. Walne, 
had the first successful case of ovariotomy in 
London ; the large incision, also, being then 
made for the first time in the metropolis. 2 .... 

" The first successful operation in a London 
Hospital did not occur till [Sept. 22 3 ~], 1 846 — Mr. 
Caesar Hawkins being the operator 

"Dr. Charles Clay, of Manchester, com- 
menced his career as an ovariotomist, Sep- 
tember 12, 1 842/ and saved three out of four 
patients this year. He soon became the most- 
distinguished ovariotomist living." .... To 
him, "more than to all other operators, the 
credit belongs of having placed the operation 
of ovariotomy on a sure foundation." .... 

"Up to 1 866, he [Dr. Charles Clay] had 
operated one hundred and thirty-seven times, 
and had ninety-five recoveries." .... 

1 London Med. Gazette, Oct. 9, 1840-41, vol. xxvii., p. 83. 

2 Obstetrical Transactions, vol. v., p. 65. 

3 London Med. Gazette, Oct. 9, 1840-41, vol. xxvii., p. 65. 

4 British Record of Obstetric Medicine, vol. L, p. 179, et seq. t 
and Medico-Chirurgical Review, October, 1843. 



I2 6 CRITICISMS AND COMMENTS. 

" Dr. Clay was graduated at the University 
of Edinburgh, and had Mr. Lizars as one of 
his preceptors. He commenced practice in 
1822, and therefore had had twenty years of 
experience as a surgeon before performing his 
first ovariotomy, a successful case, in Septem- 
ber, 1842. In his report of that case he claims to 
have performed the first operation of ovariot- 
omy in England by the long incision ; which dis- 
tinction is also asserted for him by Mr. Walne. 1 

" Dr. [James R.] Simpson, of Edinburgh, was 
his early and intimate friend, and obtained his 
ideas of ovariotomy, which he so eloquently 
defended in 1846, from witnessing many of Dr. 
Clay's earlier operations, and some of them upon 
his own patients. The term ovariotomy was sug- 
gested by Professor Simpson to Dr. Clay. . . . 

" Taking a retrospect of his own labors in 
connection with ovariotomy, in March, 1863, 
when he had operated one hundred and eight 
times, with seventy successes, Dr. Clay thus 
expresses himself: .... 'Such will readily 
admit that a rate of rather more than seventy 
per cent, of recoveries is a victory in modern 
surgical art worth contending for.' 2 .... 

1 London Medical Gazette, December 16, 1842. 

2 Obstetrical Transactions, vol. v., p. 65. 



CRITICISMS A XT) COMMENTS. 12 y 

[Sir] " T. Spencer Wells commenced his 
career as an ovariotomist, in February, 1858, 
and which must, probably, ever remain unri- 
valled, he having in less than fourteen years, 
up to September 1, 1S71, performed the oper- 
ation of ovariotomy four hundred and forty 
times.". . . . 

[328 cases cured, 112 died, recoveries 74.54 
per cent.] 

"In this year (1863), Dr. Thomas Keith, of 
Edinburgh, performed his first operation ; and, 
up to January 1, 1872, having performed one 
hundred and thirty-six operations [with one 
hundred and eleven recoveries], he has attained 
to the highest success yet achieved in Europe 
— 81.61 per cent 

"The whole number of reported cases of 
ovariotomy, in Great Britain, up to December 
1, 1863, is three hundred and seventy-seven, of 
which, two hundred and twenty-eight, or 60.68 
per cent., were successful, and one hundred and 
forty-nine patients died 

"During the last seven years (1863 to 1870) 
not less than six hundred and fifty ovariotomies 
have been performed in Great Britain, making 
a total of between one thousand and eleven 
hundred operations. [See table, page 137.] 



I2 8 CRITICISMS AND COMMENTS. 

" In France, Delaporte was the first to recom- 
mend the operation of the extirpation of the 
diseased ovary, in 1774. 1 .... 

" Nothing favorable to ovariotomy was pub- 
lished in France, excepting the thesis by Sam- 
uel Hartman d'Escher, in 1808, up to the year 
1844. Sabatier had opposed the operation by 
every imaginable argument. 2 Boyer considered 
its feasibility an illusion, and says : ' The least 
reflection suffices to show the danger and the 
impossibility of this operation, which has not 
been practised, and probably never will be. 3 

" The first operation of ovariotomy in France 
was performed on April 29, 1844, by Dr. 
Woyerkowsky, of Quingez (Doubs). 4 .... 

" On September 15, 1847, tne second opera- 
tion of ovariotomy, in France, was performed by 
M. Vaullegeard, of Conde-sur Noireau (Cal- 
vados). 5 ... It was in this year that Velpeau 
pronounced against ovariotomy, regarding it 
as an indication of foolishness and an act of 
madness. 6 

1 Memoires de l'Academie de Chirurgie, 1774, tome iv., p. 96. 

2 JVIedecine Operatoire, Ed. Dupuytren, vol. ii., p. 503. 

3 Maladies Chirurgicales, vol. viii., p. 458. 

4 Journal de Medecine et de Chirurgie Pratique, Paris, 1847. 

5 Journal des Connaissances Medico-Chirurgicales, Juin, 1848. 

6 Gazette des Hopitaux, No. 99, 1847. 



CRITICISMS AND COMMENTS. J2 g 

"Up to this time [1856-57] ovariotomy had 
been completed but four times in France — 
twice successfully, and twice unsuccessfully. 
. ... In the meantime, in this country [United 
States], the operation had been performed, up 
to the close of 1856, ninety-seven times, and 
fifty-four times successfully ; in England, one 
hundred and twenty-three times, with seventy- 
one recoveries ; and in Germany, forty-seven 
times, with but thirteen cures, and thirty- four 
deaths [See tables, pages 136, 137, and 

133.] 

"In these circumstances it is not, at first, 
easy to account for the opposition, and even 
the virulence, manifested so generally, by the 
members of the French Academy of Medicine, 
against this operation. The discussion on ova- 
rian cysts and their treatment was commenced 
in October, 1856, and continued till the next 
February, 1 the following members, half of 
them eminent surgeons, participating in it : 
Velpeau, Cruveilhier, Cloquet, jobert (de 
Lamballe), Malgaigne, Huguier, Guerin, Gim- 
elle, Trousseau, Piorry, Moreau, Robert, Barth, 
and Cazeaux. With a single exception, all these 

1 Reported in the Bulletin de l'Academie Imperiale, from 
October, 1856, to February, 1857. 

9 



1 30 CRITICISMS AND COMMENTS. 

gentlemen condemned ovariotomy as a rash, 
unjustifiable procedure. 

Dr. Peaslee continues : " I will quote from 
several of the surgeons just mentioned, 1 merely 
premising that Piorry, a physician, admitted 
that 'in certain circumstances we might attempt 
the excision of ovarian tumors ; but to do this 
one must possess an American audacity ' {une 
audace Americaine?) 

" Malgaigne : 'A great deal has been said in 
America and in France respecting the extirpa- 
tion of ovarian cysts ; an operation too radical, 
as it seems to me, and of a nature to place 
patients too absolutely beyond all resource. . . 
The alleged statistics prove nothing. All know 
what statistics are worth when all the successes 
are collected, and the reverses are omitted.' 

" Cruveilhier : ' There is no curative for mul- 
tilocular cysts, for there can be but one method 
of cure, and that by extirpation. And, although 
this operation may be invited, to some degree, 
by the isolation of the cyst, the perfect integ- 
rity of the surrounding organs, and the facility 
of the operative procedure, although it has 
been performed quite a large number of times 

1 Sessions of November 6, 13, and 20, 1856. Bulletin de 
l'Academie Imperiale, tome ii., p. 25. 



CRITICISMS AXD COMMENTS. x 3 l 

with success, especially in England and in 
America, I do not think that this daring opera- 
tion should be allowed a citizenship in France ; 
success does not always justify rash proceed- 
in 0-s.' 1 

" Huguier : ' In spite of the statistics we re- 
ject it in a manner almost absolute.' 2 

"Jobert (de Lamballe) : 'Extirpation is a 
very dangerous thing, which should very rarely 
be resorted to.' 3 

"Velpeau : ' The extirpation of diseased ova- 
ries is a frightful operation, which ought to be 
proscribed, though the cures announced were 
real.' 4 

" Moreau : ' For myself I think this operation 
should be placed among the prerogatives of 
the executioner.' 5 

" Eminent as all these speakers were, as 
mere surgeons," Dr. Peaslee says, "They were 
scarcely qualified to decide the question before 
them at all, and certainly not without the most 
careful examination. 

" Malgaigne's invidious accusation was not 
sustained by the facts ; while the conclusions of 
Cruveilhier were inconsistent with his own 

1 Bulletin de l'Academie Imperiale, tome xxii., p. 90. 

2 Ibid., p. 113. 3 Ibid., p. 154. 
4 Ibid., p. 220. 6 Ibid., p. 226. 



!^2 CRITICISMS AND COMMENTS. 

admissions respecting the success of the opera- 
tion and the absolute insufficiency of every 
other mode of treatment. A single one, how- 
ever, of the participants in that discussion had 
a special right to speak with authority on that 
subject. His special studies and his constant 
acquaintance in practice with the nature and 
progress of ovarian tumors qualified him to 
hold an intelligent opinion on this subject. 

"I allude to the distinguished surgeon- 
accoucheur Cazeaux, whose voice alone was 
raised in defence of the operation. 1 .... 

" It was but a repetition of the experience of 
the first reports of cases of ovariotomy by Dr. 
[Ephraim] McDowell. When they reached 
Philadelphia, Dr. Physick, the great surgeon of 
that time, would not deign to notice the cases, 
or justify the operation. But Dr. James, the 
Professor of Obstetrics in the University of 
Pennsylvania, at once perceived the great 
advance made by this operation, and published 
the report in a journal of which he was one of 
the editors. 2 .... 

" It is, also, a pertinent fact in this connection 

1 For a report of this interesting speech see Peaslee's Ovarian 
Tumors, p. 302; also, Monograph on Ovariotomy, p. 45, and 
loc. cit., p. 181. 

2 Eclectic Repertory, 1817. 



CRITICISMS AND COMMENTS. j^ 

that not a sinele member of the Obstetrical 
Society of London has raised an objection to 
the principle of ovariotomy, though several of 
them were for years opposed to it (among 
them Dr. Hall Davis, Dr. West, Dr. Savage, 
and Dr. W. Tyler Smith), until they became 
acquainted with the facts. 1 

"In contrast with their French confreres, the 
English provincial surgeons early accepted the 
operation of ovariotomy, as we have seen ; 
though those of the metropolis generally re- 
mained indifferent, rather than decidedly op- 
posed to it .... 

"It is not surprising that the wholesale de- 
nunciations of ovariotomy, which I have quoted 
from the highest and most influential medical 
tribunal in France, should have checked its pro- 
gress : and thus we find that for the next five 
years, or up to the commencement of 1862, 
only three more attempts at ovariotomy were 
made in that country. These were by Hergott, 
and Michel, in November, 1858 ; 2 Boinet, in 
February, 1859 ; 3 and Richard, in April, 1861. 4 
All of these were fatal cases 

1 Monograph, p. 45, 

2 Gazette Medicale de Strasbourg, 1859. 

3 Gazette des Hopitaux, 1859, P- S~ l - 

4 Gazette Hebdomadaire, 1862, p. 531. 



1 34 CRITICISMS AND COMMENTS. 

"In i860 the memoir of M.Jules Worms, 
* Sur l'Extirpation des Tumeurs cystiques 
de l'Ovaire,' appeared in the Gazette Hebdojna- 
daire de Medecine et de Chirurgie. x Being 
equally familiar with the French, German, and 
English languages, a good observer, and a 
highly educated physician, M. Worms con- 
scientiously applied himself to the inquiry re- 
specting the actual results which had been 
achieved by ovariotomy, especially in England ; 
and after much labor he arrived at the conclu- 
sion that ovariotomy is a valuable surgical re- 
source, and that it would doubtless, at some 
day, save many lives in France." . . . [See 
table page 137.] 

In Germany: "Whether the report of Dr. 
Ephraim McDowell's first three cases of ovari- 
otomy, published in 181 7, as we have seen, had 
been read by any of our German confreres, 
does not appear; but it is certain that, in less 
than two years thereafter (in May, 181 7), Dr. 
Chrysmar, of Isny, Wiirtemburg, performed 
this operation for the first time, in Europe, 2 and 

1 Pp. 642, 658, 690, 741, and 804. 

2 The first three operations of Dr. Chrysmar were reported 
by Dr. Hopfer, of Biberbach, in Journal fur Chirurgie und 
Augenheilkunde. Herausgegeben von Dr. Von Grafs, und 
Dr. P. F. Von Walther. Zwolfter Band Erstes. Heft. pp. 60-87. 
Ibid., pp. 85-87. 



CRITICISMS AND COMMENTS. \^ 

six years before the first attempt of Mr. Lizars. 
Dr. Chrysmar, also, repeated the operation 
twice more before the end of the year 1820. 
The first operation was unsuccessful. The 
second in 1820, was performed in fifteen min- 
utes ; the patient recovered, and two years 
afterward had a child at full term. The third 
case was unsuccessful. 1 .... 

" The operation of ovariotomy was attempted 
by Dieffenbach, of Berlin, in 1828, but not 
finished. 2 His patient, however, recovered. . . 

" The first who boldly defended ovariotomy 
in Germany, was Biihring, of Berlin. He at- 
tempted to obtain a footing for it, as the only 
radical cure in all forms of ovarian dropsy. 
His monograph, entitled, Die Heilung der 
Eierstockgeschwulste, was published in 1848. . . 

" Dutoit 3 remarks, that the history of ovari- 
otomy in Germany presents only a series of 
membra disjecta, rendering it very difficult to 
give an exact account of its development in 
that country [See table page 138.] 

1 Bulletin de Ferussac, tome xviii., p. 86, und Journal fur 
Chirurgie und Augenheilkunde, B. xii., p. 62. 

2 Rust's Magazin, B. xxv., p. 349. 

3 Die Ovariotomie und England, Deutschland, und Frank- 
reisch, Wurzburg, 1864, pp. 45. 



I3 6 



CRITICISMS AND COMMENTS. 



Ovariotomy in the United Statfs. 

(From 1853 to 1864.) 



Years. 


Cases. 


Cured. 


Died. 


Years. 


Cases. 


Cured. 


Died. 


1853 • • • 


8 


7 


I 


1859 . . 


7 


4 


3 


1854 • • • 


11 


8 


3 


1800 . . 


3 


3 





1855 . . . 


21 


6 


15 


1861 . . 


3 


2 


1 


1856 . . . 


11 


8 


3 


1862 . . 


4 


2 


2 


1857 • • • 


5 


4 


1 


1563 . . 


3 


2 


1 


1838 . . . 


5 


3 


2 











The total of the reported cases, up to 1864, is 117; of which 68, or 
58.12 per cent, recovered, and 49 died. 

(From January 1, 1864, to October 10, 1871 ) 



Operators * 


Cases. 


Cured. 


Died. 


Per cent, of 
recoveries. 


Atiee, W. L 


246 


172 


74 


70.00 


Kimball, G. .Lowell, Mass.) . 


121 


80 


41 


66 11 


Dunlap, A. (Ohio) 


60 


48 


12 


80 00 


Peaslee, E. R. 


28 


19 


9 


6785 


White 


25 


17 


8 


6800 


McRuer (Maine) . 


22 


16 


6 


72.72 


Thomas ..... 


27 


18 


9 


66.66 


Bradford, J. P. (Kentucky) . 


3° 


27 


3 


90.00 


Emmet ..... 


17 


8 


9 


47-o5 


Sims, J. Marion 


12 


10 


2 


83-33 


Miner 


9 


4 


5 


44-44 


Axford 


9 


6 


3 


66.66 


Crosbv ..... 


5 


2 


3 


40.00 


Bennett, Ezra P. (Connecticut) 


4 


3 


1 


75.00 


Green ..... 


8 


5 


3 


62.50 


Tewksburv ( Portland) . 


7 


3 


4 


42.86 


Beebe (Chicago) . 


6 


4 


2 


66.66 


Hill (Augusta, Maine) . 


6 


3 


3 


50.00 


Noeggerath .... 


6 


1 


5 


16.66 


Smith, A. G 


5 


3 


2 


60.00 


Jackson (Chicago) . 


4 


3 


1 


7500 


Mussey, R. D. { Cincinnati) . 


3 


1 


2 


33-33 


Total 


660 


453 


207 


68.63 


Deduct cases previous to 1864 1 


38 

622 








included in above table ] 








Total 


since J 


anuary 1, 


1864. 



The total repoi-ted cases up to January 1, 1864. is 
Add total number of cases since January 1, 1864 



117 

622 



Total number of cases reported up to October 10, 1871 739 

For the particulars respecting the ovariotomies reported in this country, 
from 1853 to 1863 inclusive, reference is made to the work of Dutoit. 

1 For names and reports of cases of ovariotomists previous to 1864, 
see Dr. Peaslee's work, pp. 238-267. 



CRITICISMS AND COMMENTS. 



137 



Ovariotomy in Great Britain. 

(Up to January 1, 1871-72. ) 



Ope ators. 



Wells, T. Spencer . 

Clay. Charles. 

Keith, Thomas (end of 1871) 

Brown, I. Baker (to 1870) 1 . 

Bryant, Thomas (to 1870) 1 . 

Smith, W. Tyler (to 1870) 1 . 

Willett (to 1870)1 . 



Cases. 



To;al 



440 

2^0 

136 

120 

28 

20 

12 

1006 



Cured. 


Died. 


Per cent, of 
recoveries. 


328 

182 


TI2 

68 


74-54 
72.80 


III 

84 
17 


25 
36 
11 


81.61 
70.00 
60.71 


16 


4 


80.00 


4 


8 


33-33 


742 


264 


73-75 



Note. — As this table is made up of operations performed by the most 
experienced ovariotomists in Great Britain at that date (1872), and does 
nut include isolated cases of other practitioners who were not as success- 
ful, the percentage of recoveries, of course, is greater than if the table in- 
cluded all operations up to that date. — M. Y. R. 

Ovariotomy in France. 

(Up to March 31, 1S67. Made up from Boinet's Table. 2 ) 



Operators. 



Kceberle . 
Boinet 

Maisonneuve . 
De mar quay 
Nelaton 
Pean 

Richards, A. 
Gosselin . 
Le Croix (de Beziersj 
Desgranges 
Serre (d'Alais) . 
Laumonier (1781) 
Woyerk-owsky (1844) 
Rigaud (1844) 

Vaullegeard (1847) 
Other operators who had each per- 
formed one ovariotomy up to 
March 31, 1867, 

Total in Boinet's table 
Other cases not reported . 
Add cases classed by Boinet as not 
published, including 12 of Nelaton's 



Rejecting, as we should, Laumonier's] 
ease, Rigaud's case (unfinished), 
Boinet's first case (degenerated I 
fibroid), Kceberle's case of uterine \ 
fibroma, Boinet's case of uterine 
fibroid in 1865, and Maisonneuve's | 
unfinished, J 

Total up to March 31, 1867 



Cases. 


Cured. 


Died. 


24 


16 


8 


7 


4 


3 


7 





7 


6 





6 


4 


2 


2 


4 


3 


1 


4 





4 


3 


1 


2 


3 


3 





2 


2 





2 


2 





1 


1 





1 


1 





1 





1 


1 


1 





25 


8 


17 


95 


44 


5i 


4 





4 


i 2 3 


5 
49 


18 


122 


73 


6 


2 


4 


116 


47 


69 



Per cent, of 
recoveries. 



66 66 
57-14 



75.00 



32.00 



40.51 



Grensei 



2 Boinet's Maladies des Ovaries, 1867. 



133 



CRITICISMS AXD COMMENTS. 



Ovariotomy in Germany. 

(Up to January i, 1870.) 

Dr. Peaslee states : " The whole number of ovariotomies in Germany, 
up to the commencement of 1870, is 180, of which 75 resulted in a cure, 
and 105 were fatal. The recoveries are, therefore, only 41.66 per cent.'' 

" Including only the operations of the three most experienced opera- 
tors, the following is the result : 



Operators. 


Cases. 


Cured. 


Died. 


Per cent, of 
lecoveries. 


Nussbaum .... 

Stilling 

Spiegelberg .... 


34 
17 
14 


18 
8 
8 


16 

9 
6 


52.94 
4706 

57-14 


Total 


65 1 34 


3. 


5 2 -3° 



Dutoit's Table. 

(Up to November 30, 1863.) 

"This table is intended to include all cases of completed ovariotomy in 
the United States, Great Britain, France and Germany, up to November 
30, 1863. In all respects it is prepared with the utmost care." 



Countries. 



United States , 
Great Britain 
France . 
Germanv 



Total 



Cases. 


Cured. 


Died. 


117 


63 


49 


379 


230 


149 


26 


12 


14 


55 


, 15 


40 ! 


577 


325 


252 i 



Per cent, of 
recoveries. 

58.12 
60.68 

46.15 
27.27 

56-32 



Summary of Cases of Completed Ovariotomy in the 
United States, Great Britain, France, and Germany. 

(Up to 1870-71.) 



Countries. 



United States (to 1870-71). 

(739 cases to Oct. 10, 1871) 
Great Britain (to 1870-71) 
France (to March 31, 1867) . 
Germany (to January 1, 1870) 

Total 



Cases. 


Cured. 


Died. ! 


660 


453 


207 


1006 


742 


264 


116 


47 


69 


180 


75 


105 


1962 


1317 


645 ! 



Per cent, of 
recoveries 



68.63 

73 75 
4051 
41.66 



67.13 



Showing an increase of 11. 13 per cent, of recoveries during the years 
from November 30, 1863, to 1871. Since that date the percentage of re- 
coveries in ovariotomy has been greatly increased, until now it is one of 
the most successful of difficult surgical operations performed. 



CRITICISMS AXD COMMENTS. 1 39 

Dr. Peaslee goes on to say: "Ovariotomy 
has very recently been performed for the first 
time, if at all, in most of the countries on the 
Continent which have not yet been mentioned 
in the preceding historical sketch. The scattered 
facts which have been accessible to me will be 
here stated." .... 

In Austria: "Ovariotomy had never been 
performed before 1866, and but twelve times 
since. Of these twelve cases only one re- 
covered Ovariotomy must, however, 

soon be generally accepted in this country also ; 
as the following extract from the Surgical 
Reminiscences of Professor Billroth, of Vienna, 
now being published, 1 demonstrates: 'Up to 
the present time, I am tolerably contented with 

my results Hitherto, I have performed 

ovariotomy nine times, and of these patients 
only two have died ; giving, therefore, only a 
mortality of 22.2 per cent. The first four cases 
recovered, one after another, then the fatal cases 
occurred; to be followed again by three recov- 
eries. The first case is related in my Zurich 
Chirurgische Klinik, and the second, third, and 
fourth cases in the Chirurgische Klinik, pub- 
lished at Vienna, in 1868.'" .... 

1 In the Wiener med. Wochenschrift, 1871. 



^O CRITICISMS AND COMMENTS. 

In Spain : " Ovariotomy was first performed 
in this country, and unsuccessfully, by Dr. F. 
Rubio, of Seville. 1 " 

In Italy: "It is asserted by Fehr, 2 that the 
first operation of ovariotomy, in Europe, was 
performed by an Italian physician, Dr. Emiliani, 
of Faenza, in 1815, this being four years in ad- 
vance of the operation by Chrysmar, of Isny." 

In Sweden ; "Two successful operations were 
performed by Mesterton, at Upsala, in 1862." 

In Finland: "Haartman, of Helsingfors, ope- 
rated in February, 1849. The patient died in 
two days, of peritonitis." 

In Poland: "In i860, Bryk operated in Cra- 
cow; the patient dying four days afterward." 

In Switzerland: "Breslau, of Zurich, operated 
unsuccessfully, in October, 1862, and afterward 
three times successfully. Dr. Montel, of Vevay, 
had a successful operation in 1865. It was a 
case of large polycyst. 3 

In Belgium: "Dr. Boddaut, was the first 
Belgian surgeon who successfully practised 
ovariotomy." 

In Russia: "Ovariotomy was first successfully 

1 The Lancet, 1863, vol. ii., p. 636. 

2 Die Ovariotomie, p. 6. 

3 Gazette Hebdomadaire, March 7, 1865. 



CRITICISMS AND COMMENTS. 



141 



performed in Russia, December 23, 1862, by 
Dr. A. Krassovsky, at St. Petersburg." 1 

In India : " Ovariotomy was twice successfully 
performed by Dr. J. M. Joseph, surgeon of the 
Civil Hospital, Combaconum. 2 In 1869, it had 
been performed three times by a native surgeon, 
Dr. Mootoosawny Moodelly, of Manargudi, 
Tanjore District." 3 .... 

In Ceylon : "Ovariotomy has been performed 
by Dr. P. D. Anthonisy." 4 

In New Zealand: "Ovariotomy has been 
successfully performed by Dr. R. Tassel, of 
Auckland." 5 

In Australia: "Dr. Tracy, of Melbourne, 
was the first to perform ovariotomy, and he 
saved ten out of his first thirteen patients." 6 

NOTE. — The limits of this work will not admit of our including in the 
foregoing article, the records of many distinguished ovariotomists, as our 
design is simply to give a brief sketch of ovariotomy in its infancy, but 
we refer the reader to the statistics which will be found in the valuable 
treatise from which these excerpts and tables are mostly taken, and, also, 
to other articles in this book. — M. Y. R. 



1 Petersburger Medicin Zeitschrift, 1863. 

2 Indian Annals of Medical Science, January, 1858. 

3 Reported in the Obstetrical Trans., 1869, vol. x., p. 119. 

4 The Lancet, 1864, vol. ii., p. 728. 

5 Ibid., 1870, vol. ii., p. 507. 

6 Ibid., 187 1, vol. ii., p. 517. 



CHAPTER IX. 

COMMENTS UPON OVARIOTOMY. 

Dr. Washington L. Atlee, in his valuable 
work entitled Diagnosis of Ovarian Tumors, 
writes as follows : "A patient seldom has any 
direct evidence of the existence of an ovarian 4 
tumor until she can feel it above the brim of 
the pelvis, or until some enlargement of the 
abdomen has occurred ; and as she does not 
usually seek the opinion of a surgeon before 
one or the other takes place, I shall confine my 
remarks on diagnosis to tumors after they have 
invaded the cavity of the abdomen. This is 
especially appropriate, as the subject will be 
discussed in reference to the question of ova- 
riotomy — an operation unlikely to be performed 
before the tumor has been elevated above the 
brim of the pelvis." He cites an interesting 
case (XIV.) entitled as follows: "An ovarian 
cyst tapped twice ; subsequently a communication 
established with the bowel, by means of which the 
contents of the cyst were evacuated and flatus 

entered the cyst." 

( 142 ) " 



COMMENTS UPON OVARIOTOMY. l ^ 

" On September i, 1869, I visited Princeton, 
New Jersey, for the purpose of operating on 
Miss E. B. R., daughter of a clergyman of that 
city, and a patient of Dr. J. A. Wikoff. 

"In his letter requesting my attendance, Dr. 
Wikoff wrote : ' She is a young lady of about 
twenty-five, has recently come under my care, 
and is suffering- from an ovarian tumor. 
Three years ago she was living near New 
York, and was under the care of Drs. Dela- 
field and Markoe, who twice tapped her pre- 
paratory to ovariotomy. Her health, however, 
failing, they deemed it prudent not to operate ; 
but just as they imagined she was about to 
die, nature interfered and relieved her in a 
most remarkable way. To within a few months 
she has been in comparatively good health, 
but now the tumor, which, I think, is composite 
in its nature, is increasing and her health is 
suffering.' 

" The following intelligent history of the case 
was written by the father of the lady: 'The 
first symptoms of this disease were noticed by 
her mother and herself in April, 1865, there 
being a hardness of the bowels, attributed by 
them to dyspepsia, which was accompanied by 
paleness and want of appetite. 



! 4 4 COMMENTS UPON OVARIOTOMY. 

" 'She paid a visit of six weeks at this time to 
some friends in Camden and Philadelphia, and 
when she returned in June there was a mani- 
fest enlargement of the stomach and waist, 
which alarmed us, when we called a physician, 
who pronounced it dropsy and gave, without 
benefit, the ordinary remedies for that disease. 
Her strength being reduced (under the treat- 
ment for two weeks) very much, and violent 
pains increasing, we took her to New York, 
and placed her under the care of Drs. Dela- 
field and Markoe, who, after treatment of a 
week, pronounced it ovarian dropsy. They 
then prescribed iron, with careful diet and ex- 
ercise, and a return to the country. In Sep- 
tember, iodine was substituted for iron, together 
with palliatives. 

" 'She continued to increase in size through 
the winter, until she was enormously swollen, 
the fluid rising very high, even displacing the 
heart, so that it seemed to beat under the 
shoulder. 

" 'Her flesh had been very much reduced, yet 
she was strong enough to go up and down the 
stairs and ride out, although very heavy upon 
her feet. She ate moderately of anything she 
fancied with tolerable comfort. 



COMMENTS UPON OVARIOTOMY. ^ 

" 'In February, iS 66, she was taken to New 
York to be tapped, not suffering- from the trip. 
My wife says that more than two pails of fluid, 
or fifty-two pounds, were evacuated, of the 
appearance and consistency of stale lees or 
porter (perhaps a little thicker). She was very 
weak after tapping, but soon rallied, and in a 
little more than a week was walking about the 
house, and then visited with comfort some 
friends in the city. She soon began to fill 
again, although it did not show for a month. 

" 'She regained strength and flesh rapidly, 
and seemed well notwithstanding the gradual 
increase in size until July, when her health be- 
gan to suffer. 

" ' In the latter part of August there seemed to 
be a regular recurrence of fever at night, which 
Dr. M. thought to be independent of the dis- 
ease, and for which he prescribed (although he 
did not see her) without effect. During the 
intense heat of that season, nervous symptoms 
of an alarming character set in with the nightly 
fever. 

"'On Friday night they intensified, and the 
next day continued so that the family physician 
said that her brain was affected. 

" 'Saturday night she had a spasm, accompa- 



I4 6 COMMENTS UPON OVARIOTOMY. 

nied and followed by violent demonstrations, 
screaming-, gritting the teeth, and terror, like 
delirium trei?ie?is. 

"' Between two o'clock, a.m., Saturday, and 
two o'clock, p.m., Sunday, she had six spasms. 
At the latter hour (Dr. Markoe arriving from 
Long Branch) she was persuaded to be tapped, 
and remained calm during the operation, about 
three-quarters of an hour. 

" ' Three-fourths of a pailful of gelatinous fluid 
was drawn away, with sensible relief, although 
the excitement (which Dr. Markoe pronounced 
hysterics) subsided but little. She seemed 
strong, and could not be kept quiet through 
the night, but the next morning was very much 
exhausted, so that we used brandy and hot 
bricks at the feet to restore her. 

"'She gradually, however, increased in 
strength and grew a little more calm after a 
week, but was far from being like herself. 

"'It was evident that she was slowly filling 
again, but her habits were so whimsical and 
secretive that we could not inform ourselves 
particularly. 

" ' During this time she went up and down in 
the house and out of doors as she pleased, but 
would not see any one, even the members of 



COMMENTS UPON OVARIOTOMY. 1A ^j 

the family more than could be avoided ; went 
to the table after meals, and helped herself, as 
she would not be waited on. 

" 'About the last of September, 1866, we no- 
ticed a manifest diminution, accompanied by 
violent diarrhoea^ for two weeks or more, end- 
ing in entire relief, both of body and mind, as 
she became calm and natural just in propor- 
tion as the fluid passed away. 

" 'In two or three weeks she had regained 
both strength and flesh, and seemed like herself. 
She spent several weeks in Camden and Phila- 
delphia, enjoying herself, during this winter as 
much as ever before. 

" ' In the summer of 1867 she noticed a lump 
as large as a walnut (she thinks on the right 
side), which gradually increased during the 
summer to the size of an orange, and in the 
fall seemed to flatten and slowly to spread 
laterally. But from the time she noticed it 
first, in 1867, until in 1868, it seemed to be 
hard over the stomach. She could push it with 
ease (as she expressed it) from one side of the 
stomach to the other, and, after it became larger, 
could lift up the sides of it with her hands under 
the skin. September, 1868, she noticed a ten- 
dency to increase, but it gave her no incon- 



I4 8 COMMENTS UPON OVARIOTOMY. 

venience until within two months, when Dr. 
Wikoff became cognizant of the case, to whom 
I refer you for further details.' 

"Two or three days before visiting the pa- 
tient for the purpose of performing ovariotomy, 
she was taken suddenly with diarrhoea, accom- 
panied with copious, watery and dark-colored 
discharges, affording her considerable relief, 
and causing some subsidence of the abdominal 
enlargement. Still she was as large as a 
woman at full period of gestation. 

'• When lying on her back the percussion 
sound was resonant over the whole abdomen 
in front, and dull below and along the sides, 
just as is found in ascites. 

"In an upright position, resonance existed 
over the epigastrium ; and when lying on 
either side it was noticed in the opposite side. 
A large cyst, with multilocular deposits in its 
walls, could be detected, occupying the whole 
cavity of the abdomen, containing both liquid 
and air — some of the liquid, no doubt, having 
escaped into the bowel, and flatus from the 
canal having found its way into the cyst. This 
was made still more evident by succussion. 

" The body of the uterus was wholly buried in 
a mass occupying the superior strait of the pel- 



COMMENTS UPON OVARIOTOMY. i^g 

vis, and was immovable. The os tincae could 
scarcely be detected on the left side of the 
pelvis. The sound entered the uterus two 
inches. 

"Under these circumstances I declined to 
operate, as the opening in the bowel was calcu- 
lated to cause a fatal result. Besides, nature 
itself was making an attempt to relieve the 
patient. 

11 September 30, 1869, Dr. W. wrote : ' Miss 
R. is gradually improving. The cyst has com- 
pletely emptied itself, and she is no larger than 
natural. The discharges kept up for about 
three weeks from twenty-four to ten a day." 

Nature in this peculiar case was the success- 
ful physician. 

" Percussion and palpation become very im- 
portant aids in detecting the existence and 
location of ovarian and other abdominal tumors. 
A patient should be examined with the abdo- 
men uncovered, and first in the sitting posture. 
The whole surface of the region should then be 
explored by palpation, varying the pressure. 

"By this means we are all able, through the 
sense of touch alone, to detect the presence of 
peritoneal fluid between the surface of the 
tumor and the walls of the abdomen ; to decide 



I 5 o COMMENTS UPON O VA RIO TO MY. 

on the character of the tumor ; to detect the 
existence of smaller bodies in the walls of a 
large cyst, and frequently to trace the outlines 
of several cysts, by the sulci which divides a 
polycystic mass. During this examination the 
eye cf the surgeon should follow all the 
motions of the hand — the general contour of 
the abdomen, as well as the form of the several 
parts, being worthy of the closest observation. 

'*' Different inferences would be drawn ac- 
cording to the impression imparted to the hand 
and the shape of the abdomen. 

" The patient being still in a sitting posture, 
percussion should next be practised by placing 
the palmar surface of the finger of one hand 
upon the abdomen and striking it with the ends 
of the fingers of the other hand, and noticing 
closely the sounds elicited. 

" It is well known that when percussion is 
made over any part containing air there will be 
a reverberation of sound, which is denominated 
resonance, while over a liquid or a solid a flat 
or dull sound is returned. Therefore an ova- 
rian or other solid tumor, located anterior to 
the viscera, must give off a dull percussion 
sound over the anterior part of the abdomen, 
and indeed over the whole space occupied by 



COMMENTS UPON O VARIO TOMY. 1 5 x 

it; whereas the intestines, which always con- 
tain more or less air, must return a resonant 
percussion sound, and are usually thus traced, 
occupying the lumbar, hypochondriac, and epi- 
gastric regions, being crowded beyond the 
borders of the tumor. A patient, therefore, 
having an ovarian tumor filling the abdominal 
cavity and crowding closely upon the viscera, 
will almost universally be free from a resonant 
percussion sound over every part of the abdo- 
men except in the regions above stated, and 
not unfrequently this sound is absent in one or 
more of these localities." 

In illustrating a peculiar condition to which 
Dr. Atlee was anxious to call the attention of 
the profession, viz., the character of the fluid 
removed by tapping, and the value of this opera- 
tioji as a means of diag7iosis, he writes as fol- 
lows : 

"We have seen that even Mr. Spencer 
Wells, whom we all delight . to honor as the 
highest authority in ovariotomy, was corrected 
in his diagnosis of a case only by the charac- 
ter of the fluid, so exactly did it resemble, in 
every feature, an ovarian tumor. This circum- 
stance, instead of disparaging our great master 
in England, adds to his character, by proving 



!^ 2 COMMENTS UPON OVARIOTOMY. 

how closely observant he is of every phase of 
differential diagnosis, and should warn others, 
of less experience, not to be too sanguine in 
expressing an opinion until they have adopted 
every possible means of examination." 

Dr. Edmund Randolph Peaslee, in his work 
on Ovarian Tumors, published in 1872, sets 
forth the facts establishing the claim of Dr. 
Ephraim McDowell to priority as an ovarioto- 
mist, and gives a history of the four cases of 
Mr. Lizars, from which the following excerpts 
are taken : 

"From 1786, when John Hunter published 
an opinion I have already quoted (p. 235), that 
hydatid ovarian cysts may be extirpated when 
they first begin to grow, I do not find the extir- 
pation of ovarian tumors considered by any 
writer in Great Britain till the year 1824. Dr. 
McDowell's report of his first three cases, in- 
tended for Mr. Bell, had slumbered in Mr, 
Lizars's possession for more than seven years, 
and was now to see the light. While I do not 
explain the former fact, Mr. Lizars had himself 
now to publish a case of attempted ovariotomy, 
and Dr. McDowell's report was appended. 

"The patient had been believed by Mr. 
Lizars, and 'all other eminent surgeons who had 



COMMEXTS UP OX OVARIOTOMY. 153 

seen the case/ to have had an ovarian cyst. She 
had been tapped, though it is not stated whether 
any fluid was obtained. Making an incision 
'parallel with and to the left side of the linea 
alba about two inches from the ensiform carti- 
lage to the crista of the os pubis,' he found no 
tumor at all ; that both ovaries were healthy ; 
and that the supposed ovarian tumor was 
merely an accumulation of fat under the skin of 
the abdomen, and of gas in the intestines. In 
such circumstances, Dr. McDowell's report of 
three cases afforded a precedent for his opera- 
tion, if it did not indorse his diagnosis 

"The next year, 1825, Mr. Lizars attempted 
ovariotomy three times in three successive 
months, February 27th, March 2 2d, and April 
24th. The results, however, were not flattering. 
All three were believed to be cases of ovarian 
tumor, at the time of the operations; but two 
of the tumors were not removed, on account 
of adhesions 

" Mr. Liston remarks of Mr. Lizars's first case, 
that he had himself treated this patient for 
lumbar abscess with disease of the spine. She 
recovered from the former, but the bones had 
grown together, and her stature had much 
diminished. She was now a puffy, podgy, little 



154 COMMEXTS UP OX OVARIOTOMY. 

woman, with an exceedingly prominent belly. 
She begged Mr. Liston to perform the opera- 
tion, but he endeavored to persuade her not to 
submit to it. Alluding to Mr. Lizars's other 
operations in private practice, he adds, as if he 
had assumed the control of both the operator 
and the operation, 'For I took care to prevent 
him from cutting open women's bellies in the 
hospital after he became attached to it/" 1 

Prof. W. Gill Wylie, of New York, reports one 
hundred and ten laparotomies — sixty-one con- 
secutive operations without a death. 2 He very 
judiciously says: "A number of cases were 
sent to me for operation where the patients gave 
all the subjective symptoms of serious func- 
tional disturbance, if not of actual disease of 
the- appendages ; but, on account of absence 
of any positive objective signs of actual enlarge- 
ment or disease, I refused to operate. There 
certainly are a number of cases where both 
local and general treatment fails to give relief 
from pain, and where complete loss of health 
is due, apparently, to disease or to a faulty 
action of the generative organs, and where, on 
examination, all we can find is an imperfectly 
developed, anteflexed uterus with a prolapsed 

The Lancet, February 8, 1845. 
7 Annals of Gynecology, December, 1887. 



COMMENTS UPON OVARIOTOMY. 155 

left ovary and a general condition of hyperes- 
thesia on both sides. The question is, in such 
cases, when all other means fail to give relief, 
are we justified in removing the tubes and 
ovaries to put a stop to functional activity ? 
Next, does the operation really cure such 
cases ?" 

"Taking a view of laparotomy on the other 
side, are all the unsuccessful cases truthfully 
reported ? And is an estimate of the deaths 
caused from the operation announced? 

"Surgery has its fashions in laparotomy, and 
when such is the case the operation is likely to 
be carried to excess, and the rash and incom- 
petent make mistakes, causing condemnation 
to rest upon what is good." 

Dr. Augustin H. Goelet, of New York, who 
is strongly in favor of electricity as a substitute 
for laparotomy, and who advances some good 
ideas, says: 

" When we take into consideration the risk 
involved, coupled with the fact that the ulti- 
mate result is not always what is desired, 
laparotomy can by no means be considered 
successful or satisfactory when done for the 
uterine appendages. Unless it affords positive 
relief of the symptoms which caused the pres- 



! (j 6 COMMENTS UPON O VARIO TOM i . 

ence of the disease to be detected, it cannot 
be considered even a justifiable operation. If 
pain, the main symptom which drove the pa- 
tient to seek relief, persists after the opera- 
tion, what has been gained beyond permanent 
sterility ? 

"The recovery of the patient from a danger- 
ous operation often serves to eclipse the purpose 
for which it was intended, and is mistaken for 
success, adding to the record of the successful 
operator, but in no way benefiting the patient. 
The mental impression produced upon her may 
serve to satisfy her for a time, until, when this 
subsides, she awakens to the truth that she is 
no better than before. 

" The proof of this assertion is to be found 
in the fact that a successful laparotomist has 
published an elaborate paper upon the cause 
of pain following laparotomy. Also in substan- 
tiation is the fact that operators declare that 
temporary improvement frequently follows 
laparotomy when the abdomen is only opened, 
inspected, and immediately closed, the condi- 
tion found being unfavorable. 

"The patient is often so overwhelmed by the 
magnitude of the disclosure, as well as by the 
long list of successful operations of the man 



COMMENTS UPON OVARIOTOMY. 



157 



who advises her, that she does not think to 
question the ultimate results of these perform- 
ances, but consents with a sort of resignation 
to a fate from which she is given no choice. 
Nothing else having been suggested by her 
adviser, she argues that there is no alternative, 
for the principle of the laparotomist is, ' If an 
eye offend thee, pluck it out.' If the tubes and 
ovaries are diseased, take them away. Do not 
try to cure them. Get clear of them. 

"It has been said, and with some degree of 
truth, that there are more healthy ovaries re- 
moved than diseased ones. Hence the term 
normal ovariotomy, which is a blot upon the 
escutcheon of the profession. 

"We might enumerate many surgeons who 
are opposed to promiscuous laparotomy and 
strongly in favor of ovariotomy — the latter 
the only remedy for ovarian tumor; but we 
have not space to devote to this very interest- 
ing subject." 



CHAPTER X. 

JOSEPH NASHE McDOWELL, M.D. 

As we have referred to several of the rela- 
tives of Dr. Ephraim [McDowell in this work, 
we are not to lose sight of his nephew, Dr. 
Joseph Nashe [McDowell, whose eminence as a 
surgeon and a man of brilliant intellect was 
acknowledged throughout the southern and 
western countries. 

He founded the "McDowell Medical Col- 
lege" in St. Louis, and that city owes to him 
the establishment of its most thorough and 
prosperous medical school. 

A few years after the death of its founder, 
for some reason unknown to the writer, St. 
Louis, the city of his adoption, changed the 
name of the "McDowell Medical College" to 
that of the "Missouri Medical College," which 
name it bears at the present time. 

The college is in a prosperous condition, and 
the faculty is composed of the most prominent 

physicians of the city. Many students from 

(158) 



MAI 



JOSEPH A A SHE 31CD0 WEL L. \ 5 g 

the South patronize the school, there being 
usually about three hundred in attendance. 

Although Dr. J. Nashe McDowell was born 
and reared in Lexington, Kentucky, his inte- 
rests and local attachments were closely iden- 
tified with those of St. Louis, Mo. 

He had many enthusiastic friends there and 
in the South, who warmly espoused his cause, 
and the medical profession in St. Louis recog- 
nized that fact. 

Col. Thomas Marshall Green, an exceedingly 
gifted and fluent writer, speaks of him in the 
following language : "It was not solely as a 
lecturer in medicine and surgery that the ora- 
torical gifts of Dr. Joseph Nashe McDowell 
shone conspicuously ; of varied and extensive 
culture, his gifts made him the delight of lite- 
rary circles, and the West contained no more 
eloquent speaker on political topics than was 
this able and learned teacher of the healing 
art. 

"He abandoned the rigid Calvinism of the 
McDowell without adopting the gentler tenets 
of Arminianism; discarding their Federalism, 
his devotion to the 'lost cause' made him an 
exile from his home and country. 

" Thus died a man whose learning, genius, 



1 60 JOSEPH XASHE MC D O WELL. 

and enthusiasm, had his life been guided by the 
principles and religion of his fathers, would 
have placed him at the very head of his profes- 
sion, and have made him eminent in any walk 
of life and in any country." Col. Green con- 
tinues: "From Dr. Samuel Gross, with whom 
he frequently came in angry collision, his 
genius and superior talents extorted the admis- 
sion that Dr. McDowell was an eloquent and 
enthusiastic teacher of anatomy, who had a re- 
markable gift of speech, and who could enter- 
tain and amuse a class in a wonderful way." 

In a recent conversation with Dr. John H. 
Tate, of Cincinnati, Ohio, that gentleman re- 
marked " that he considered Dr. Joseph Xashe 
McDowell the finest demonstrator of anatomy 
in the whole country." 

In 1838 he delivered so able a lecture before 
the students in the Ohio [Medical College as to 

o 

give him great celebrity as a lecturer and 
teacher. As a surgeon he performed more 
general operations, and amputated more arms 
and legs than any practitioner in the city of St. 
Louis. 

He was a very profane man, using oaths 
freely. On an occasion he was hurriedly called 
in to amputate the limb of a poor unfortu- 



JOSEPH NASHE MCD O WELL. 1 5 : 

nate laboring man, who had accidentally had 
his leg terribly crushed in some machinery con- 
nected with a saw mill. Dr. McDowell went 
as soon as possible to the relief of the sufferer, 
and as he entered the threshold of the door com- 
menced swearing at a dreadful rate, saying, 
"Where is the d — n rascal? I have come to 
cut him to pieces, d — n his trifling soul ! Why 
did he not keep away from the d — d machinery? 
and other such vituperative expressions con- 
tinued to pour from his lips until he reached 
the bedside of his patient. 

He turned to the man, who was writhing- in 
agony, and said : " Sir, I have come to cut you 
up, d — n you ! The instruments are all ready," 
displaying, with the remark, the glistening 
instruments that were to do the work. 

The poor sufferer, paralyzed and dazed, real- 
ized how completely he was in the power of the 
Doctor. 

" Now, sir, hold still and I will make quick 
work of it ; " and in a very short time the Doctor 
amputated the limb, dressed the wound, and 
had the man made as comfortable as possible. 

When the operation was over he asked the 
patient how he felt. The man replied, " Doctor, 
you frightened me so badly I did not feel you 



1 6 2 JOSEPH NA SHE MC D O WEL L . ' 

cut my leg off." The Doctor then explained to 
him that he had taken this mode to lessen his 
pain, adding, " My poor unfortunate, I felt all 
your pain for you." 

The man soon recovered ; and frequently 
expatiated on his operation, telling his friends 
how Dr. McDowell had cut his leg off, and what 
a great man he was. 

Apparently the brusque, off-handed manner 
of the Doctor caused many persons to judge 
him wrongfully, and to believe him void of that 
tender sympathy which it is so necessary for a 
physician to possess. Such was not the case ; 
on the contrary, a warm and generous heart 
beat within his bosom, and he- was unusually 
kind and considerate with the poor. Much of 
his practice was gratuitous. 

His appearance attracted general attention. 
He was above the medium height, and from his 
boyhood had been i'ema?'kably thin and angular, 
having sharp-cut features and small, penetrating 
eyes that seemed to look into the very recesses 
of one's soul. This emaciated appearance 
suggested to the medical students the pseudo- 
nym of " Sawbones," a name he was well known 
by, not only among the young men but among 
his friends. 



JOSEPH NA SHE MC D O WEL L. 1 6 3 

When he was a youth much of his time was 
spent in the family of his uncle, Dr. Ephraim 
McDowell, and it was there that he formed 
an ardent attachment for his cousin, Mary 
McDowell, whose beauty has been alluded to. 

When he made his vows expressing more 
than cousinly affection for her, she, with a sin- 
cerity and frankness that characterize a genuine 
noble-hearted girl, candidly told him that she 
could only regard him in the light of a relative, 
never in that of love, desiring him earnestly to 
banish from his mind such a thought as making 
her his wife. 

She confided to her father, as became a 
daughter, what she had heard from her cousin. 
Dr. McDowell immediately sought his nephew, 
and with kind, but decisive, manner empha- 
sized her decision and request. The nephew 
became angry and reflected on his uncle, 
charging him with influencing his daughter 
against him, an inference in which he un- 
doubtedly was mistaken. 

From that time a coolness existed between 
the two, the nephew leaving his uncle's house 
and never returning, nor did he ever forgive 
him. He sought new fields of friendship, and 
in course of time a new field of love. 



1 64 JOSEPH NASHE MCDO WELL. 

The two never met again. The younger 
carried with him to the grave his feeling of 
hatred toward the elder, and never would listen 
to any eulogy bestowed on him for his grand 
surgical achievements. Shortly after this occur- 
rence he removed to Cincinnati, Ohio, and 
commenced the practice of medicine. 

Surgery was his specialty. He was con- 
sidered a bold operator. Dr. Daniel Drake, 
then the leading physician in Cincinnati, be- 
came devotedly attached to the young man, 
seeing in him the. promise of an able practi- 
tioner. This friendship was later cemented 
after another manner. Dr. McDowell wooed 
and won the sister of his patron. After his 
marriage to Miss Drake he removed to St. 
Louis, and it was there that he built for himself 
a reputation for skilful surgery and remarkable 
determination of character, that not even time's 
destructive touch has taken from him. 

Attached to the college was one of the most 
complete museums to be found at that time in 
the land. It contained an attractive and ex- 
tensive collection of specimens relating to 
surgery, rare and ancient warlike weapons, 
birds, statuary, and many things of interest. 
The Doctor was fond of displaying his curiosi- 



JOSEPH XA SHE MC D G WEL L. 1 6 5 

ties to visitors, and no one thought of eoine to 
St. Louis without seeing the McDowell Mu- 
seum. 

The eccentricities and the erratic manner 
and habits of Dr Mc Dowell invited many com- 
ments and severe criticisms. It was never 
questioned, however, that he was a man of 
pronounced learning, and as well a genius in 
his profession. 

When the guns of Fort Sumter sounded a 
knell of war that was to wreck so many happy 
and prosperous families both in the north and 
in the south : when the echoes resounded 
throughout the length and breadth of the 
land, calling men to arms — brother against 
brother, and father against son, men hastily 
responded to the call, and went forth to battle, 
many, alas, to fall within the gates of their own 
homes. 

Dr. McDowell, inspired by that spirit of 
chivalry which characterizes the American peo- 
ple, offered at once to the Confederates his ser- 
vices as a surgeon. Bidding adieu to his family 
and friends in St. Louis, he was assigned duty 
in Mississippi, where he immediately entered 
on active work. 

Many wounded and gallant soldiers were 



1 66 JOSEPH NASHE MCDO WELL. 

restored by his skilful operations ; his efforts to 
relieve the sick and wounded were unparalleled. 
He was out night and day on his mission of 
mercy, always responding punctually to the call 
of duty. 

The writer, being banished from New Or- 
leans by General Benjamin Butler, when his vast 
army of men occupied that city, it was her 
pleasure to meet Dr. McDowell on several 
important occasions. 

The one in which he was most prominent 
and took a very conspicuous part, was where a 
dreadful collision occurred between two trains 
freighted with many people. One of these 
cars was packed with wounded soldiers, fresh 
from the memorable siege of Atlanta, the other 
coach contained refugee ladies with their help- 
less children fleeing from an advancing foe. 
On board the soldiers' train there were many 
wounded federal soldiers who had been taken 
prisoners. 

Immediately after the accident (the scene of 
which beggared description) surgeons from 
every rank, and ladies by the hundred, flocked 
to the scene of distress, with lint, bandages, 
coffee, camphor, and cologne, all of them ready 
and willing - to relieve the suffering and soothe 



JOSEPH XASHE MCDOWELL. 



167 



the dying in their last struggles. The blue 
and the gray uniforms mingled together upon 
their beds of anguish, and Dr. McDowell, in 
his kind, benign spirit, administered alike to 
both as did also the Southern ladies. Many a 
Northern soldier owed his life to Dr. McDowell 
and to Southern women on that occasion. The 
question was not then asked, "What side is he 
on?" Gentle and tender hands administered 
to all alike. 

On another occasion the writer met Dr. 
McDowell under different circumstances, when, 
his feelings being greatly outraged toward the 
North, and especially toward its then chief 
magistrate, Abraham Lincoln, he remarked that 
" to him was due all the terrible sacrifice of life. 
That to him was due this civil war." 

At the close of this unfortunate conflict he 
returned to St. Louis an embittered man. 

His college was a wreck ; his handsome 
museum, in which he had taken so much pride, 
and had expended so much money, was gone, 
not a vestige of anything being left to mark the 
spot wdiere once were crowded so many things 
of interest to him. He then sought his once 
extensive library. Alas ! only to find the 
empty shelves standing out in bold relief, as if 



1 68 JOSEPH NASHE MC D WELL. 

in defiance. Not a book was to be found. 
The bare walls of the once famous " McDowell 
College" were left standing as if in mockery. 
He peered through the broken panes of glass 
(for there was scarcely a whole one left in the 
building), and looking out into what was once 
a beautiful garden of flowers, tufted with grass, 
he saw filthy debris of every description, to- 
gether with the remnant of a gallows. (The 
authorities had used the building as a prison, 
and the once cultivated yard had been made 
the hangman's ground ; several men had there 
expiated their crime upon the gallows.) The 
Doctor, in despair and gloom, turned from 
these harrowing scenes, his mind quite unset- 
tled as to what was best to be done. The 
ground on which the college walls were left 
standing still belonged to him, but as his fi- 
nances were running low, and it certainly would 
be necessary to expend a great deal of money 
upon the building before it could be made 
habitable, he was truly at a loss as to how he 
should proceed. 

He sought the advice of some of his old and 
trusted friends in St. Louis, whom he knew 
had his interest at heart, and they advised 
that he return to his college, and with the 



JOSEPH NASHE MCDOWELL. j5q 

pecuniary assistance they were willing to give, 
that he put things in readiness to recommence 
his work. 

This generous offer was accepted, and in a 
short time the old college building put on a 
new dress. 

The Doctor had a crank idea that in that 
commodious building one room should be set 
apart and designated as "Hell" in commemo- 
ration of Abraham Lincoln, who, although long 
since dead, held a bitter place in the heart of the 
eccentric old doctor. It was my pleasure to 
visit my relative (Dr. McDowell) soon after he 
refitted up his college and residence ; and after 
his congratulations of meeting were over, he re- 
marked " that he wanted to take me to "Hell" 
Not comprehending his meaning, I replied: 'T 
hope I shall never be so unfortunate as to see 
h— 1. " 

He immediately caught me by the arm, and 
leading me through several narrow hallways, 
we finally halted in front of a heavy double 
door, when drawing a large brass key from his 
pocket and placing it in the lock, the door soon 
yielded and swung wide open. 

I noticed as I passed into this strange room 
that the word " Hell," in gilt letters, stood out 



I -O JOSEPH NASHE MCDO WELL. 

in bold relief over the entrance. The room 
was very long and narrow, and lacked carpet or 
other furniture. 

On entering this Dantean abode, the first 
salutation that greeted me was the venomous 
hissing of an unusually large rattlesnake that 
was to be seen darting out its fiery tongue be- 
tween the bars of its cage. 

To the left a huge crocodile was noticed, such 
as crowd the southern sloughs and bayous, and 
dot the lowlands and canebrakes of the tropical 
country. The hideous reptile crept slothfully 
through his pool of tepid water, now and then 
swinging his immense jaws as though he would 
like to make a meal of us ; but he too was con- 
fined within his own limits, and there was no 
danger. 

Becoming- interested in this weird and un- 
natural place I followed the Doctor, not unwill- 
ingly and certainly with a much aroused curi- 
osity, deeper into the mysteries of his "Hell!' 

Glancing- to our rieht, we saw the bird of ill 
omen perched upon his pole, seemingly oblivious 
of us or of its surrounding- ; occasionallv it 
'would grit its bill together, causing a peculiarly 
unwelcome sound. Alongside the bird was a 
lizarcl, singing its unvaried song. 



JOSEPH NASHE MCDO WELL. l n r 

At the extreme end of a narrow hall-like I 
room a gallows had been erected, suspended / 
from which was an effigy of ex-President Abra-j 
ham Lincoln. For a moment (the scene was' 
so life-like) I was shocked and startled. 

There were several other images, one in par- 
ticular representing Lucifer and his imps. It 
was indeed a novel sio-ht to witness. Dr. 
McDowell took a lively interest in everything 
connected with this particular apartment. 

Before the late civil war, in the ante-bellum 
days, when the " McDowell Medical College" 
was at its height of prosperity, and several 
hundred students were in attendance, upon one 
occasion a very distinguished surgeon and phy- 
sician from a distance was to lecture, not only 
before the students, but others. 

Dr. McDowell, being at that time the Dean 
of the faculty, he had sent out quite a number 
of invitations to members of the medical pro- 
fession and their families. 

At the appointed hour for the lecture to begin 
the spacious hall was filled with many of the 
most prominent ladies and gentlemen in the city. 

The students had the front seats reserved 
especially for them, in order that they might 
hear more distinctly what the professor said. 



1 7 2 JOSEPH NA SHE MC DO WELL. 

When the lecturer was nearly half through, 
Dr. McDowell, who was seated upon the plat- 
form close beside the speaker, arose to his feet, 
and in the most quiet manner possible passed 
from the stage up the aisle to where one of his 
students was sitting, laughing and talking with 
a young lady. He (Dr. McDowell) took him 
quietly by the ear, and led him down to the 
front seats that had been reserved for students, 
and placed him in front of the speaker. Dur- 
ing the proceedings not a word was spoken 
by anyone. After the student had been seated, 
McDowell took his same place near the pro- 
fessor. During this singular performance he 
did not change a muscle of his face ; of 
course, the audience was convulsed with laugh- 
ter, but all understood why the young man had 
received such a public chastisement from his 
preceptor — he was not in his place. 

The eccentricities of Dr. McDowell were so 
great that had he lived in the present time his 
warmest friends would have been constrained 
to classify him with the legion of " cranks." 
His many peculiar acts and idiosyncrasies would 
certainly have justified such placing. 

Although never really acknowledging his 
belief in spiritualism, yet when any noted lee- 



JOSEPH NA SHE 31 C D O WEL L. iy$ 

turer on that subject was in the city the doctor 
was always found among the audience. Dr. 
Tuckett, an intimate friend, relates the following 
conversation had with him : 

" I see that you listen to the spirits some- 
times." "Yes," was the reply, "there is agreat 
deal more in the matter than a man can ex- 
press without being thought a d — n fool." 

" You are right," was added. " But have you 
ever had an experience or seen any manifesta- 
tions ?" "Yes ; a confounded sight more than 
I tell people. However, I will tell you," he 
continued, "what I know, and how I was saved 
by my mother's spirit." 

11 A German girl died with a very unusual 
disease, and we were determined to get her 
body for dissection. We got it and laid it in 
the college. The secret leaked out, and the 
Germans got their backs up and made things 
lively for us. It was planned by them to come 
one night and hunt over the college to see if 
the body was there to be dissected. 

" I received a note at my house at 9 o'clock 
of an evening warning me that the visit was to 
be that night. 

" I went down to the college about 1 1 o'clock, 
thinking to hide the corpse. When I got there 



174 JOSEPH NA SHE MC D O WEL L . 

all was quiet. I went through the dissecting 
room, with a small lantern in my hand, in the 
direction of the body. I picked the cadaver up 
and threw it over my shoulder to carry it to 
the top loft to conceal it between the rafters, 
or place it in a cedar chest that had stood in a 
closet for years. 

"I had ascended one flight of stairs, when 
out went my lamp. I laid down the corpse 
and re-struck a light. I then picked up the 
body, when out went my light again. I felt 
for another match in my pocket, when I dis- 
tinctly saw my dear, old mother standing a 
little distance off, beckoning to me. 

" In the middle of the passage was a window ; 
I saw her rise in front of it. I walked along 
close to the wall, with the corpse over my 
shoulder, and went to the top loft and hid it. 
I came down in the dark, for I knew the way 
well : as I reached the window in the passage, 
there were two Germans talking, one had a 
shotgun, the other a revolver. I kept close 
to the wall and slid down the stairs. When I 
got to the dissecting-room door, I looked down 
the stairs into the hallway: there I saw five or 
six men lighting a lamp. I hesitated a moment 
as to what I should do, as I had left my pistols 



JOSEPH NA SHE MC D O WEL L. x 7 5 

in my pocket in the dissecting-room where I. 
took the body. I looked in the room, as it 
was my only chance to get away, when I saw 
my spirit mother standing near the table 
from which I had just taken the corpse. I had 
no light, but the halo that surrounded my 
mother was sufficient to enable me to see the 
table quite plainly. 

" I heard the men coming up the stairs. I 
laid down whence I had taken the body and 
pulled a cloth over my face to hide it. The 
men came in, all of them being armed, to look 
at the dead. They uncovered one body — it 
was that of a man, the next a man ; then they 
came to two women with black hair — the girl 
they were looking for had light flaxen hair. 
Then they passed me ; one German said : 
' Here is a fellow who died in his boots ; I 
ofuess he is a fresh one.' 

" I laid like marble. I thought I would jump 
up and frighten them, but I heard a voice, soft 
and low, close to my ear, say, ' Be still, be still.' 
The men went over the building and finally 
down stairs. I waited awhile, then slipped out. 
At the corner of Gratial Street, I heard three 
men talking German ; they took no notice of 
me, and I went home. 



176 



JOSEPH NASHE MCDO WEL L . 



" Early in the morning I went to the college 
and found everything all right. We dissected 
the body, buried the fragments and had no fur- 
ther trouble. " 

" Then, Doctor, you feel satisfied that the 
spirit of your mother saved you from that 
trouble ? 

"I know it," he replied. "I often feel as 
though my mother is near me when I have a 
difficult case of surgery. I am always success- 
ful when I feel this influence. Well, let me 
stop here. I have a boy to attend to with a 
broken leg, so good-bye." And with his char- 
acteristic manner of always being in a great 
hurry, he glided out the door and into his 
buggy. 

He was very fond of the violin, and played 
many of the old popular airs. It was his cus- 
tom to amuse his friends when they would call 
upon him socially, by playing familiar tunes for 
them. 

His death occurred October 3, 1868. Three 
sons survived him. He was singularly unlike 
any of his McDowell kindred. 

Two of his sons, Drs. Drake and John 
McDowell, arrived at considerable eminence 
in the medical profession ; both filled chairs in 



JOSEPH NASHE MCDOWELL. j-- 

anatomy and obstetrics. Indeed, John Mc- 
Dowell was considered equal to his father in 
difficult operations. He had a lucrative prac- 
tice. All three of the sons are dead. 

The peculiarities of the father seem to have 
been inherited, to a certain extent, by his son 
John. 

On one occasion he drove up to his relative's 
house in St. Louis to make a social call. On 
entering the parlors he found quite a number 
of ladies and gentlemen there spending the 
evening. When tea was announced he arose 
to take his departure, excusing himself to his 
hostess, but she would not permit him to go. 
After all the guests had entered the dining- 
room Dr. McDowell detected that there were 
twelve at the table, and that his presence made 
the thirteenth. He refused to be seated ; his 
relative bantered him with being superstitious, 
when he replied: ''Well, my cousin, in honor 
to you I will take my seat, but as my presence 
makes the thirteenth /will be the first one from 
this fatal number which will pass away." 

He ate sparingly and the thought certainly 
took possession of his mind, for he alluded to 
the circumstance repeatedly, and, true to his 
predictions, in a few weeks thereafter he died. 



1 7 8 JOSEPH NA SHE MC D WEL L . 

A few years before his death Dr. Joseph 
Nashe McDowell married again : but the alli- 
ance did not prove a happy one ; his children 
wandered from home, and the old doctor sought 
comfort and solace in the Roman Catholic 
religion. 

When the iron grasp of death was upon 
him, claiming him as its victim, he calmly closed 
his eyes, passing thus to the great hereafter, 
bearing with him the loving benediction of 
his faithful friend and spiritual adviser, Father 
De Smit. 

From the early experience of his Romanistic 
convictions, this Father De Smit was his re- 
ligious adviser and companion. Dr. McDowell 
reverenced him for his piety, admired him for 
his intellect, and regarded him as the soul- 
healer and spiritual comforter of those op- 
pressed by sin and wickedness. 

Before we close this brief memoir of a gifted 
and remarkable man, we may relate another 
circumstance pointing to his peculiar nature and 
eccentricities. The idiosyncrasy relates with 
his unnatural and unheard-of mode of interring 
his infant children. After death had claimed 
them, and they were robed in their burial dress 
and ready for the burial rites, he would order 



JOSEPH NASHE MCDO WELL. j 7g 

the casket, which he had prepared expressly 
for the solemn occasion. This casket was made 
of heavy glass, and filled with alcohol ; the body 
of the infant was placed within the case con- 
taining the liquid, and the coffin securely 
cemented. 

Only the undertaker and the nearest kindred 
followed the remains to an island (several miles 
distant from the city) in the Mississippi River, 
where the grave had been prepared, and there 
the casket was lowered into the earth. 

After the death of the Doctor his surviving 
sons had the infantile remains removed to the 
family lot in Bellfontaine Cemetery and placed 
beside those of the father, where their little 
graves could not be disturbed by rises in the 
river. 

A singular coincidence : three surgeons be- 
longing to the same family, each having 
achieved professional honors and having risen 
to eminence in the medical world, now resting 
side by side in the beautiful " Bellfontaine" 
burying ground. We can only say, " Peace be 
to their ashes!' 

In reading a biographical sketch of the late 
Col. Basil Duke, whose mother was Martha 
McDowell, a member of the Virginia family of 



1 80 JOSEPH NASHE MC D O WELL. 

McDowells, we find the fact established that 
more than forty years after the death of Dr. 
Ephraim McDowell, the European people 
awakened to the fact that Dr. McDowell was 
justly entitled to be called the " Father of ovari- 
otomy," and acting on such conviction erected 
a suitable monument to his memory. 

Can this be repeated of America, the land 
of his birth ? Has a national monument been 
erected to him who was truly woman's bene- 
factor ? 

The late Dr. Jackson, in appropriate re- 
marks, seemed fully to appreciate the fact that 
America had failed to do her duty toward this 
worthy son of her land. America, the country 
that pays tribute to merit and genius — that so 
fully appreciates intellect, seems here to have 
shrunk from her duty; yet the memory of 
Dr. McDowell is as fresh in the hearts of the 
people to-day as when he braved his own life 
for humanity's sake. 



CHAPTER XI 



BIOGRAPHICAL SKETCH BY THE LATE 
DR. JOHN D. JACKSON. 

Through the kindness of Dr. Lewis S. 
McMurtry, we have been furnished a full ac- 
count of the character and services of Dr. 
Ephraim McDowell, prepared and written by 
the late Dr. John D. Jackson, of Danville, 
Kentucky, a gentleman who devoted much 
time during the latter days of his life in gather- 
ing facts relative to Dr. McDowell, for whose 
character and works he had great veneration. 

Dr. Jackson says : 

For a quarter of a century, or indeed until 
Dr. Benjamin W. Dudley, of Lexington, Ken- 
tucky, came upon the field as a lecturer upon 
surgery, Dr. McDowell yearly came before 
large classes of young men assembled at the 
medical department of Transylvania University 
from all portions of the Ohio and Mississippi 
valleys, thus possessing opportunity for extend- 
ing a reputation such as no man in the West 
ever had before him. We may say that he 

(181) 



j 3 2 SKE TCH B Y DR. JOHN D. J A CKSON. 

stood " facile princeps " in surgery west of the 
Alleghenies. 

During this time McDowell's practice ex- 
tended in every direction, persons came to 
him for treatment from all the neighboring 
States, and he frequently took horseback 
journeys for hundreds of miles. He is to be 
accepted as being in the habit of performing 
every surgical operation then taught in the 
science. 
< In lithotomy he was extremely successful. 
/ Up to 1828 he was known to have operated 
twenty-two times without a death. 

For strangulated hernia he also operated in 
a large number of cases, and there is good 
authority for stating that he successfully 
extirpated the parotid gland long before 
McClellan or any other American surgeon had 
attempted the procedure. 

Indeed there was scarcely any operation, 
from a simple amputation to tracheotomy, 
which was to be done, but that Dr. McDowell 
was sent for to perform it. 

The brevity and rather loose manner in 
which his first cases were recorded, exposed 
him to criticism, and Dr. Henderson and Dr. 
Michener, of Philadelphia, in articles in the 



SKE TCH B Y DR. JOHN D. J A CKSON. i % 3 

Repertory, reviewed him rather sarcastically 
and doubtingly ; while Dr. James Johnson, 
the caustic editor of the London Medico- 
Chirurgical Review^ did not hesitate to take 
advantage of the opportunity and declare out- 
right his total disbelief as to Dr. McDowell's 
statements. A few years thereafter, when 
accuracy of the reports had been fully con- 
firmed, he however acknowledged his previous 
error, though in a flippant and very ungraci- 
ous manner; saying: "A back settlement of 
America — Kentucky — has beaten the mother 
country, nay Europe itself, with all the boasted 
surgeons thereof, in the fearful and formidable 
operation of gastrotomy with extraction of the 
diseased ovaria There were circum- 
stances in the narratives of some of the first 
three cases that raised misgivings in our minds, 
for which uncharitableness we ask pardon of 
God, and of Dr. Macdowal, of Danville." 

In the Philadelphia Eclectic Repertory for 
October, 1819, Dr. McDowell reported two 
more cases, and in connection with them alluded 
incidentally to his critics and their criticism to 
this effect : 

"I thought my statement sufficiently explicit 
to warrant any surgeon performing the opera- 



1 84 SKE TCH B Y DR. JOHN D. J A CKSON. 

tion, when necessary, without hazarding the 
odium of making an experiment; and I think 
my description of the mode of operating, and 
of the anatomy of the parts concerned, clear 
enough to enable any good anatomist, possess- 
ing the judgment requisite for a surgeon, to 
operate with safety. I hope no operator of 
any other description may ever attempt it. 
It is my most ardent wish that this operation 
may remain to the mechanical surgeon for- 
ever incomprehensible. Such have been the 
bane of the science ; intruding themselves 
into the ranks of the profession with no 
other qualification but boldness in undertaking, 
ignorance of their responsibility, and indiffer- 
ence to the lives of their patients ; proceeding 
according to the special dictates of some 
author as mechanical as themselves, they cut 
and tear with fearless indifference, utterly in- 
capable of exercising any judgment of their 
own in cases of emergency, and sometimes 
without possessing even the slightest knowl- 
edge of the anatomy of the parts concerned. 
The preposterous and impious attempts of 
such pretenders can seldom fail to prove 
destructive to the patient and disgraceful to 
the science. It is by such this noble science 



SA'E TCH B Y DR JOHX D. J A CKSOK. 1 3 5 

has been degraded, in the minds of many, to 
the rank of an art." 

Dr. Jackson goes on to relate : 

In the summer of 1822, McDowell made a 
horseback journey of some hundreds of miles 
into middle Tennessee, and performed ovari- 
otomy in his usual way, with success, upon a 
Mrs. Overton, who resided near the "Hermit- 
age," the residence of the late President Jackson. 

Mrs. Overton was enormously obese, and 
he had to cut through four inches of fat upon 
the abdomen. The only assistance he had in 
the operation, as we have been informed, was 
from General Jackson and a Mrs. Priestly. 

General Jackson seems to have been greatly 
impressed with Dr. McDowell, and had him to 
go to his house and remove a large tumor 
growing from the neck and shoulders of one 
of his men. 

Dr. McDowell charged for his operation upon 
Mrs. Overton $500, but the husband, with a 
commendable generosity, gave a check upon 
one of the Nashville banks for $1500, which, 
upon the doctor presenting for payment, and 
discovering the presumed error for the first 
time, sent a messenger back to Mr. Overton 
to have it corrected, but that gentleman re- 



! 86 SKE TCH B Y DR - JOHN D. J A CKSON. 

plied that, far from a mistake, he felt that he 
had not even then made a full compensation 
for the great services which Dr. McDowell had 
rendered. 

How many times during his career he had 
occasion to perform ovariotomy is not now cer- 
tainly known. He seems to have been fonder 
of the scalpel than of the pen — indeed, to have 
been of that class of mankind (of which we have 
all seen specimens, even among the ablest and 
most cultivated) who have a natural antipathy 
to writing. 

He is said to have kept no notes of his cases, 
and with the exception of the communications 
quoted, we know alone of a card published in 
1826, when an effort was made to wrest his 
honors from him ; this he addressed especially 
to the medical faculty and class at Lexington, 
defending his veracity and claiming to have 
been the first to perform and establish the 
feasibility of the removal of diseased ovaries. 

However, his nephew, Dr. William A. Mc- 
Dowell, who was for five years his pupil and 
two years his partner, tells us that up to 1820 
his uncle had seven cases, six of which he wit- 
nessed, and that six of the seven were success- 
ful. 



SKE TCH B Y DR. JOHN D. J A CKSON. x gy 

After Dr. William A. McDowell removed 
from Kentucky to Fincastle, Virginia, Dr. Alban 
G. Smith succeeded to his position as partner 
of Dr. Ephraim McDowell, and while with him 
Dr. Smith twice performed ovariotomy. 

The younger McDowell stated that he had 
reliable testimony of his uncle having per- 
formed ovariotomy during his life at least 
thirteen times, exclusive of the two cases Dr. 
Smith operated upon when they were in part- 
nership, and that of the cases treated by his 
uncle, subsequent to his retiring from partner- 
ship, he had personal knowledge of the recovery 
of two ; this would make a total of thirteen 
cases with eight recoveries. 

Dr. Ephraim McDowell seems to have been 
very careless of either of an immediate present 
or posthumous fame; and to have originally 
drawn up the report of his cases at the re- 
peated solicitation of his nephew, Dr. James 
McDowell, who, up to the time of his prema- 
ture death, had been a partner of his uncle, as 
his cousin William, to whom we have alluded, 
afterward was. 

The idea that his success would be pleasing ( 
to his former preceptor, John Bell, to whom he J 
felt he owed his determination to perform the 






1 8 8 SKE TCH B Y DR. JOHN D. J A CKSON. 

operation, according to his nephew, seemed 
more than all else to have induced him to put 
his cases before the professional world. 

Long after all dispute as to the authenticity of 
Dr. McDowell's cases had ceased, the medical 
literature of the past was ransacked to find some 
one who had preceded him in the operation. 
Indeed, until the critical examination made by 
Dr. Gross, it was believed that L'Aumonier, 
Dzonde, Galenzowski, had all preceded him by 
having each done a single ovariotomy. Going 
to the original records of these gentlemen, 
it was found, however, that the first had only 
punctured an abscess of the ovary, that 
Dzonde's case was simply one of gastrotomy 
upon a boy who had a pelvic tumor, and 
that Galenzowski' s case, while really an im- 
perfect ovariotomy, was not done until 1827, 
eighteen years after the first operation by 
McDowell. 

When McDowell performed his first opera- 
tion, as he said, in the publication made of it, 
he had never heard of an attempt or success 
attending any operation such as this required. 

At present we are not aware that even the 
most persevering antiquarian research has been 
able to find undoubted ovariotomy before the 



SKE TCH B Y DR. JOHX D. J A CKSON. j Sq 

time of McDowell, for although we observe 
that Mr. Spencer Wells, in his recently pub- 
lished History of the Origin and Progress of 
Ovariotomy^ says, on the authority of Dr. Wash- 
ington Atlee, "Dr. Robert Houstoun operated 
near Glasgow in 1701, and that from this case 
it will appear that ovariotomy originated with 
British surgery, on British ground." Yet a 
reference to the original record shows very 
plainly that Dr. Houstoun was never really an 
ovariotomist in the sense of having removed 
an ovary ; his operation, like L'Aumonier's, 
consisting in laying open the diseased ovary 
and evacuating a large quantity of gelatinous 
fluid, when as he says, " I squeezed out all I 
could and stitched up. the wound in three 
places almost equidistant." 

We observe that Dr. Atlee, in his volume on 
Ovarian Tumors, dedicates the book to his 
brother, Dr. John L. Atlee, and to the memory 
of Dr. Ephraim McDowell, "The Father of 
Ovariotomy." Even had the operation been 
done many times before, forgotten or unno- 
ticed, as the cases lay among the dead records 
of the past, it should not, and it would not, 
derogate at all from the glory of Dr. Mc- 
Dowell, who had never heard of any attempt 



! qo SKE TCH £ Y DR. JOHN D. J A CKSON. 

to perform it, and who, after his performance 
of it, first succeeded in establishing it as a 
legitimate operation in the medical world. 

When we think of one living on the border 
of Western civilization, in a little town of be- 
tween three and four hundred inhabitants, far 
removed from the opportunity of consultation 
with any one whose opinions might be of 
value to him in such a case, and nearly a thous- 
and miles from the nearest hospital or col- 
lege dissecting-room at which he might have 
had an opportunity of studying and practising 
upon some body who had perished of the dis- 
ease, before performing upon the living a new 
and untried operation of such fearful magni- 
tude ; and learn of his having pondered over 
and contemplated all the difficulties, when with 
a full sense of the dangers liable to environ 
him in the attempt, without ether or chloro- 
form, assisted by probably only one fully 
skilled physician or assistant, with one or two 
medical students — see him attempt and success- 
fully perform the first ovariotomy — our admi- 
ration for Dr. Ephraim McDowell's courage 
and skill rises to its full height, and we feel 
that he is justly entitled to have applied to 
him Horace's words, describing the stoutness 



SA'E TCH B Y DR. JOHX D. J A CKSON. \ g i 

of the heart of the first manner who had bold- 
ness to go down to the sea in ships : 

Illi robur et ses triplex 
Circa pectus erat, qui fragilem truci 

Commisit pelago ratem 
Primus. 

Dr. Ephraim McDowell was always remark- 
able for his strength and agility, and while at 
Edinburgh was pronounced the swiftest foot- 
racer of the whole University. He was one of 
the kindest-hearted and most amiable of men, 
overtiowine with cheerfulness and eood humor. 
He seemed totally devoid of all austerity, a 
tinge of which is generally characteristic of the 
scholar and professional man, and never ap- 
peared to assume that there was any difference 
between the plane of his vocation and that of 
the humblest, unlettered artisan. 

This seemed instinctively to strike all who 
came in contact with him, and an easiness 
amounting almost to familiarity existed be- 
tween him and his fellow-citizens. So true was 
this with the masses, that probably because of 
such fact he was not generally appreciated for 
his true worth. 

A man arrogating to himself in manner 
nothing above the populace, would not, as may 



192 



SKETCH B Y DR. JOHN D. J A CKSON. 



readily be believed, be acknowledged to be 
superior to his sphere, save by those gifted 
above common penetration. Never, however, 
was this air of familiarity in the slightest degree 
tinctured with professional demagoguery. His 
bitterest enemies did not once accuse him of 
this. 

By a gentleman of keen perception, yet 
living, whose father's family physician he was, 
we are told that never was there a man whose 
life was freer from the acts of the charlatan, 
or more entirely devoid of all the petty "tricks 
of trade" which too frequently disgrace the 
medical profession. 

While in the sick-room, though fond of gos- 
siping about local matters and events of the 
day, he habitually refrained from discussing 
things medical, or any of the affairs of his 
rivals, with some of whom he was known to be 
on anything but good terms. 

While in daily competition with certain mem- 
bers of the profession whose chief strength 
lay in the application of such arts, they and 
their artifices were held in supreme contempt 
by him. From what we can learn, one of the 
endeavors of these gentlemen, who knew they 
never could approach McDowell by fair com- 



SKE TCH B Y DR. JOHN D. J A CRTS ON. \ g 3 

petition, was to impress the community with 
the idea that there was a sort of essential in- 
compatibility between surgery and medicine ; 
that in proportion as a man is superior in sur- 
gical knowledge and dexterity, that by so just 
much is he inferior in the intricacies of the 
practice of medicine, whose arcana were not so 
appreciably evident to the public as the more 
demonstrable work of the surgeon ; or, as they 
were in the habit of putting it: "That while 
McDowell was a bold surgeon, he was but a 
poor fever doctor." 

So far from this last being the case, however, 
he kept himself fully abreast of the progress of 
medicine by reading all that was new on the 
subject, and was probably really as far in ad- 
vance of his competitors in physic as in sur- 
gery. 

Certainly we now know that in the treat- 
ment of fever he was in some respects ahead 
of his time, though at variance with the gener- 
ally accepted doctrine of his day and the pre- 
vailing customs of the physicians of his section. 
At that time it was customary to give more or 
less mercury in the treatment of every fever, 
while to allow a patient cold water after a dose 

of calomel or blue mass was thought to be 
13 



1 94 SKE TCH B Y DR. JOHN D. J A CKSON. 

recklessly dangerous. The standard treat- 
ment of the country was to let a patient have 
no drink but what had been warmed ; and this 
usually consisted of water in which a piece of 
burnt bread-crust or warm toast had been 
soaked. On the contrary, Dr. McDowell used 
to tell his patients that there was no danger in 
cold water while the skin was hot ; and while 
such was the case he allowed them to use it 
ad libitum. 

I have heard an old gentleman, who lived in 
an adjoining county, tell how, when he was a 
boy, and one of his brothers lay very ill with a 
fever, Dr. McDowell was sent for; and of the 
anxious fears of the family while obeying the 
directions of the doctor, who had the patient 
laid naked upon the floor, and bucketful upon 
bucketful of cold water poured over him to his 
great relief and ultimate recovery. 

Dr. McDowell looked on Sydenham and 
Cullen as the master minds in medicine, and 
set their works above all others in practice. 

To the system of over-drugging, then so 
common, he was an enemy ; believing that 
drugs as then given by the mass of the profes- 
sion, without discrimination, were producing in 
the aggregate more harm than good. Though 



SKE TCH BY DR. JOHN D. J A CKSON. j q r 

practising medicine with more than ordinary 
ability, yet his inclinations were always espe- 
cially toward surgery ; and it was his custom, 
when practicable, to throw as far as possible 
the medical practice into the hands of his 
partner. 

He was a most accomplished anatomist, and 
used every winter, in conjunction with his office 
students, of whom he generally had two or 
three, to dissect in the upper story of an old 
abandoned building, which had for years been 
the county jail ; and in his office, in the course 
of time, quite a number of anatomical prepa- 
rations, the work of his own hands, were 
deposited. 

When having determined upon the perform- 
ance of any capital operation, his custom was 
to drill thoroughly beforehand the students who 
were to assist him. Not only this, but he com- 
pelled each one to give a succinct history of 
the nature of the difficulty requiring the opera- 
tion, the anatomy of the parts involved, and the 
tissues to be divided, and then would, himself, 
rehearse the different steps of the operation. 

It was the invariable opinion of all compe- 
tent judges that for coolness and dexterity as an 
operator they had never seen Dr. McDowell's 



! g6 SKE TCH B Y DR. JOHN D. J A CKSON. 

equal. From the moment he took the knife in 
hand preparatory to operating, he seemed to 
become enthused, and to the bystanders looked 
quite a different person. When we consider 
the results to mankind of the labors of this 
surgeon, we do not hesitate to rank him with 
the great benefactors of the race. 

Before the nineteenth century, not one of the 
most astute or boldest of the healing profession 
could promise anything hopeful to women af- 
flicted with ovarian dropsy. The doctor when 
^called to such a case, could only say, " Two 
'years of life filled with gradually increasing 
/misery is the full compass of the days allotted 
to a woman who may find that she has an ova- 
rian tumor, and unless God works a miracle 
in your case, this is your fate." 
^ But now, since the establishment of ovari- 
otomy by Ephraim McDowell, the matter 
stands quite differently, for the physician of 
our era says, "It is true that without an opera- 
tion you are inevitably doomed to death after a 
few years of miserable suffering, but by ovari- 
otomy you have seventy chances or even more 
out of a hundred (much better than one under- 
going the amputation of a thigh), not only of 
recovery, but of a full restoration to health." 



SA'E TCH B Y DR. JOHN D. J A CKSON. \ gy 

Dr. Peaslee has made a calculation based 
on the known law of the length of life of a 
woman who has an ovarian tumor uninterfered 
with, and the average age of all the recorded 
cases of ovariotomy up to 1870, and the proba- 
bilities of longevity of healthy women of that 
age according to the most approved tables of 
life insurance, and has shown that in the 
" United States and Great Britain ovariotomy 
has, within the last thirty years, directly con- 
tributed more than thirty thousand years of 
active life to woman, all of which would have 
been lost, had ovariotomy never been per- 
formed" — to say nothing of saving her more 
than a thousand years of untold suffering. 

With these facts before us, most devoutly 
indeed should all women bless the name of 
Ephraim McDowell. 

To one living in Athens in the days of the 
glory of ancient Greece and conferring such a 
boon on the human race as ovariotomy, rank 
among the demigods, with a temple and an 
altar, would have been accorded by acclama- 
tion of the people. 

Had he lived in the palmy days of the Roman 
Republic, the highest civic honors, a medal, 
and a statue, if not a shrine in the temple, 



1 98 SKE TCH B Y DR. JOHN D. J A CKSON. 

would have been his by a decree of the Senate ; 
and had Ephraim McDowell been born and 
had he flourished in any one of the principalities 
of Europe instead of the United States, long 
since would the government, proud of such a 
son, have conferred titles of distinction upon 
him and his children while living, and erected a 
fitting monument to his memory when dead. 

But it seems that to us, of the boasted Great 
Republic of the Western World, the prover- 
bial charge regarding the ingratitude of repub- 
lics is literally applicable in the case of the sub- 
ject of our sketch. 

Such were the thoughts which crowded upon 
us when recently we made a pilgrimage to the 
burial ground of the Shelby family at "Travel- 
lers' Rest," and after climbing the stone-wall 
enclosure finally succeeded in making our way 
through brambles and wild flowers to a lichen- 
covered sandstone slab which simply bore 
the name of Ephraim McDowell, and which 
covers the remains of one to whom the whole 
world should feel deeply grateful, and of whom 
Kentucky and the American Republic may 
always be justly proud. . 

While Kentucky and nearly every State of 
the Republic has, at different times, voted 



SKE TCH B Y DR. JOHN D. J A CKSON. j qq 

monuments, statues, or paintings to one. and 
another political favorite, or military idol of the 
day, the worthiness of the commemoration of 
none of whom is to be compared to that of 
McDowell ; and while if our State (Kentucky) 
should erect the tallest shaft in all the land to 
mark his resting-place she would but justly 
honor the worthiest of all her children ; yet does 
his fame not rest with us alone, nor is the benefi- 
cence of ovariotomy confined alone to our part 
of the globe. Like Jenner, McDowell has 
been a benefactor for the Generations f a n 
time and all countries, and as a few years ago 
the world at large contributed to the statue of 
the former, now erected in Hyde Park, London, 
so do we think it most fitting that all nations 
should be allowed to contribute to a suitable 
statue to Ephraim McDowell, to be erected at 
Danville, the scene of the first ovariotomy. 
* But since Dr. McDowell has been woman's 
i special benefactor, we think it would be emi- 
nently appropriate that the gratitude of this 
sex of all nations should be allowed to dis- 
play itself in the erection of a fitting memorial 
to its friend. Indeed, that a bronze statue of 
life size should be erected solely from voluntary 
contributions made by those women throughout 



200 



SA'E TCH B Y DR. JOHN D. J A CKSON 



the world who owe their lives to the opera- 
tion of ovariotomy. The following inscription 
might be placed upon the memorial rock : 

Many women throughout the 
world who, by ovariotomy, have 

been rescued from otherwise 

inevitable death, have, by their 

combined contributions, 

erected this statue in grateful 

commemoration of 

Dr. Ephraim McDowell, 
who, A. D. 1809, 

first removed an ovarian 
tumor and established the 

Operation of Ovariotomy. 

»o>*Jo* 

Ephraim McDowell, M.D, 






CHAPTER XII. 

SKETCH BY W. W. DAWSON, M.D. 
EXCERPT FROM ADDRESS BY RICHARD J. LEVJS, M.D. 

In an address delivered before the Ameri- 
can Medical Association, at Newport, R. I., 
in 1889, by W. W. Dawson, M.D., then Presi- 
dent of the Association, and one of the most 
prominent and successful surgeons of America, 
occurs the following : 

" A brief review of medical teaching in this 
country will be pardoned — it may be profitable 
— it will certainly illume the present, and may 
be somewhat of interest to the future. 

"The first medical lectures were delivered by 
Dr. John Morgan and William Shippen in 1767, 
in Philadelphia. Dr. Rush and Dr. Physick 
soon after participated, and in 1768 the Medical 
Department of the University of Pennsylvania 
was organized ; that great school which is 
steadily 'advancing to the highest station. 

"Philadelphia was a small, a provincial, city at 
that time ; now she is only second to the great 
metropolis in numerical strength, but second 

( 201 ) 



!02 



SKETCH B Y DR. W. W. DA WSON. 



to none in the thorough equipment of her 
medical schools. 

" Contemporaneous with Philadelphia an or- 
ganization was projected for medical instruc- 
tion in New York. 

"In 1767 the first steps were taken which 
resulted in the school ever since known as the 
1 College of Physicians and Surgeons,' one 
which challenges the confidence of all. 

" The medical colleges of New York, en- 
dowed not by government but by her public- 
spirited citizens, have won the honors which 
they wear so well. 

"In 1785 the first school was organized in 
Boston. The chairs were four, and the ses- 
sions four months. Harvard is the outgrowth 
of this humble beginning of that provincial 
faculty. 

"In 1800 the first medical instruction was 
given in Baltimore ; since then the schools of 
Maryland have occupied a deservedly high posi- 
tion. Recently one of her citizens made an 
endowment by which the 'Johns Hopkins 
University' will be equipped for the most 
thorough work, experimental work, laboratory 
studies, a range and grade of investigation en 
rapport with the spirit of the times. This great 



SKETCH BY DR. IV. IV DAWSON. 203 

benefactor has also given to Baltimore one of 
the most completely endowed hospitals to be 
found on this earth. 

"The great Mississippi valley was yet un- 
known, but soon after the close of the Revolu- 
tion emigration began, and as early as 1799 
Dr. Samuel Brown organized the medical 
department of Transylvania University. 

"Dr. Benjamin Dudley effected a re-organiza- 
tion in 18 19. 

" This school, after many prosperous years, 
having graduated men who acquired distinc- 
tion at home and abroad, was transferred, or 
rather most of the faculty removed, to Louis- 
ville, when and where the University of Louis- 
ville was founded. 

" During the early part of the century medi- 
cal schools were organized in several of the 
Eastern States, usually under State or church 
patronage. Most of them exist to-day. Some 
of the most distinguished men in our profession 
have been associated with these institutions. 

"As the West and South were peopled, 
medical schools were established in cities and 
promising towns. As early as 18 19 Dr. 
Daniel Drake secured the charter of the 
Medical College of Ohio, and had it legally 



204 SKETCH BY DR. W. W. DAWSON. 

connected with the City Hospital. The faculty 
constituted the hospital staff, the members of 
which were required to give clinical lectures — 
the first forward step on the continent in blend- 
ing didactic with clinical instruction. 

"The physicians in South Carolina began 
medical teaching in 1823, and those of Louisi- 
ana in 1835. I n both of these States schools 
of high character have been maintained." 

Dr. Dawson further said: "The advance in 
medical education is a gain most distinctly pro- 
nounced by a remark made by one of our dis- 
tinguished fellows, an American-bred physician, 
of whose fame we are all justly proud. 

" In conversation Dr. Battey said : ' When 
I began practice thirty years ago there was 
scarcely a graduate within fifty miles of my 
residence ; now, however, there is hardly a 
practitioner in the same territory who is not a 
graduate, and year after year a portion of our 
young men leave home to avail themselves of 
clinical advantages to attend post-graduate 
instruction.' 

" Could anything show more forcibly the con- 
servative and steady growth of medical culture ? 

" In our own country, as well as elsewhere, 
great achievements have often been made in 



SKETCH BY DR. W. IV. DAWSON. 20$ 

the provinces and not always under the shadow 
of the universities. 

" One of the greatest operations 1 waited for 
years for a metropolitan disciple — one to take 
it up ; and that too, long after the provinces at 
home and abroad had demonstrated its vital 
utility, its claim upon the scientific and skilful 
surgeon. 

" Some of the classical schools of Oxford and 
Cambridge were organized as early as the 
thirteenth century, but the systematic scientific 
study of medicine and surgery came long sub- 
sequently, not for four hundred years later — 
about the middle of the eighteenth century. 

" It was first projected in Great Britain, and 
soon after in our Atlantic cities. Unlike the 
old world, our fathers had a wilderness to con- 
quer before progress could be made. 

" When the pilgrim fathers left England, read- 
ing and writing were rare accomplishments, 
chimneys in that country had just been in- 
vented, and flock beds were luxuries. 

" The adventurers — the emigrants to these 
shores from that ancient and imperfect civiliza- 
tion — had much to learn, but in the midst of 
their pitiable ignorance, facing great hardships 

1 Ovariotomy. 



206 SKETCH BY DR. W. W. DAWSON. 

and pressing wants, they were quick to pro- 
vide educational opportunities for all. 

"The results of their efforts are apparent — 
they are before us. Could more have been 
accomplished in one century? 

"Had Sidney Smith been a physician and 
given to reading, he would not, even in 1850, 
have asked the questions : Who reads an 
American book? What does the world owe 
to American physicians and surgeons ? This 
reverend gentleman, this famous critic, could 
not have heard of Ephraim McDowell, whose 
brief paper, detailing his first three cases of 
ovariotomy, published in the Philadelphia Eclec- 
tic Repertory, in 18 17, was of more value, did 
more for the conservation of human life than a 
score of ordinary publications. 

" Our first half century may be poor in books, 
but it abounded in strong, devoted, conscien- 
tious, and brave men, men who with the most 
limited resources accomplished the grandest 
results. 

"They compelled success, because they de- 
served it. The ink was hardly dry upon that 
cynical pen when anaesthesia was presented by 
the profession, so poor, as he supposed, in 
valuable works. 



SKETCH BY DR. W. W.DAWSON. 2 0J 

"But what country or age can match in great 
contributions to the relief of the suffering, 
McDowell, Sims, Bigelow, Sayre, Battey, and 
Emmet, and that trinity of men, Wells, Mor- 
ton, and Jackson, who gave anaesthesia to the 
world. The heart of every American physician 
is filled with thankfulness when he remembers 
that in the providence of God this great boon 
to humanity was vouchsafed to this country. 
The very ground upon which stands the Massa- 
chusetts General Hospital is sacred to us all. 

"Associated with the discoverers must ever 
be the name of Dr. Hayward, who performed 
the first operation under the strange Letheon. 
Previous to this, operative surgery was slow, 
tedious, and almost cruel. Contrast it to-day 
with what it was previous to 1847, what grand 
strides it has made under the direct support of 
anaesthesia, and its almost equal co-laborer 
antisepsis. The great cavities are invaded, and 
invaded safely ; the abdomen has become a 
familiar field. 

"The story of Ephraim McDowell, though so 
often repeated, humanity never tires of hearing. 

u To us he belongs, and to us only ; we can- 
not share his fame with another, we would not 
if we could. Who can measure the relief which 



208 ADDRESS B Y DR. R. J. LE VIS. 

his operation has bestowed upon suffering 
woman ? — not only woman, for his was the 
genius which opened the way to laparotomy in 
both sexes." 

Dr. Richard J. Levis, in an address at the 
thirty-ninth annual session of the Medical 
Society of the State of Pennsylvania, alluded 
to Dr. McDowell as follows : 

"The records of the experience of individual 
practitioners, of intelligent and trained minds 
would be a gain to surgical progress, and tend 
to avoid the transmission of traditional errors. 

" From practitioners in regions far away from 
medical centres, in such locations as are abroad 
styled provincial, have originated some of the 
most valuable practical discoveries and ad- 
vances. 

"There may be instanced the discovery of 
vaccination in rural England, by Jenner ; the 
origin of ovariotomy by McDowell, in what was 
then a frontier region of Kentucky ; and the 
very beginning of practical gynecology, by 
Marion Sims, in the obscurity of Northern 
Alabama. 

" It is said that the ploughman, tilling the 
fields of the western slope of our continent, 
who keeps his eyes intently on the furrow, may 



SKETCH BY DR. W. W.DAWSON. 20 O 

occasionally find nuggets of gold ; and so the 
faithful toiler amidst human ills is liable to 
unearth jewels of fact, which, garnered and 
recorded, will add to the wealth of surgical 
knowledge." 

14 



CHAPTER XIII. 

DESCRIPTION OF ONE OF THE METHODS OF 
PERFORMING OVARIOTOMY. 

Dr. John H. McIntyre, of St. Louis, Mo. 
a very successful ovariotomist, has, by request, 
kindly furnished us with a detailed account of 
the present mode of doing the operation of 
ovariotomy, in order that the reader may be 
able to contrast the performance of these 
times with that of its first accomplishment in 
the history of the medical world, by Ephraim 
McDowell, eighty years ago. The abdominal 
cavity was up to that time, unexplored ; and as 
a very prominent and successful practitioner of 
Chicago, Illinois, crudely said : " McDowell cut 
away the abdominal barriers, and the surgeons 
walked in and reaped the harvest of his daring 
surgical adventure." So long as Dr. McDowell 
lived, it certainly was his earnest desire that the 
operation ovariotomy should not be abused 
by the medical profession ; as the reader will 

(2IO) 



OVARIOTOMY. 2 II 

perceive in his (Dr. McDowell's) reply to criti- 
cisms published in vindication of the opera- 
tion. Hence he urged surgeons to be guarded, 
and not abuse it in a reckless way ; that, with 
judicious caution, ovariotomy would prove 
woman's benefactor, but abused, her curse. 

Dr. Mclntyre says : 

I may remark that it gives me pleasure to 
speak of the present status of this operation 
as compared to the opposition which it met 
in its earlier days, as it is to-day one of the 
most successful and brilliant of any of the major 
operations, adding thousands of years to the 
life of woman ; and smiles and happiness to 
households which would have been left gloomy 
and desolate by the loss of her who was its 
centre and its sunshine. For many years the 
opposition to this operation was most bitter and 
revengeful. Gentlemen occupying high posi- 
tions in the profession stigmatized it in most 
unmeasured terms. Well do I remember the 
denunciations hurled upon its justifiableness by 
the elder Meigs, in a lecture before a class of 
the Jefferson Medical College of Philadelphia ; 
and, student as I was at that time, I saw that 
his judgment was biassed, and I resolved then 
and there, that when the proper time arrived / 



212 OVARIOTOMY. 

would do the operation. In a review of Mr. 
Clay's work in the British and Foreign Medical 
Review, of 1843, v °l- xv ' 1 - P- 4° 2 > tn i s passage 
is found: "To our thinking, the facts need no 
comment. We earnestly hope that they will 
prevent the younger members of the profession 
from being dazzled by the alleged success of 
this operation." A fundamental principle of 
medical morality which we conceive is outraged 
whenever an operation, so fearful in its nature, 
often so immediately fatal in its results as gas- 
trotomy, is performed for the removal of a dis- 
ease, of the very existence of which the sur- 
geon is not always sure ; of the curability of 
which, by his interference, he must be in the 
highest degree uncertain. 

At a meeting of the Royal Medico-Chirur- 
gical Society (England), November 12, 1850, 
no less a man than Lawrence said: " I have no 
experience of ovariotomy. I have not per- 
formed it, and unless my view of the matter 
should be essentially altered, I never shall." 
And he further asked the question, "Can this 
operation be encouraged, and continued with- 
out danger to the character of the profession?" 
[n one of my conversations with Keith (then 
of Edinburgh), in 1879, while complimenting 



OVARIOTOMY. 213 

him on the brilliant results of his work, and the 
esteem and admiration in which he was held by 
the profession in America, he replied : " It was 
not always so pleasant. Not long after I 
beean to do ovariotomies, one of the heads of 
the profession here — one of the best and most 
honest of men — indeed, he was my old teacher, 
and one to whom I looked up to as my profes- 
sional father — said to me : ' Fellows like you 
should simply be handed over to Mr. Lothian.' 
Now Mr. Lothian was the public prosecutor, 
and you can easily see what that meant." 

In contradistinction to the above, a few years 
later, Sir James Paget stated : " This operation 
is one of the greatest achievements of surgery 
in this century, and the gain is not limited to 
ovariotomy alone ; the success of this operation 
has led to an extension of the whole domain of 
peritoneal surgery. Surgeons act more boldly 
than before in operations involving the perito- 
neum, and the influence for good is not limited 
by the increased success of ovariotomy, but 
extends through many departments of opera- 
tive surgery, and will always continue to be 
felt in the whole practice of surgery." 

Peaslee, in the beginning of 1873, asserts 
that it may be shown that in the United States 



I 



214 OVARIOTOMY. 

and Great Britain alone, ovariotomy has, within 
the last twenty years, directly contributed more 
than thirty thousand years of active life to 
woman ; all of which would have been lost had 
ovariotomy never been performed. His calcu- 
lations by which he arrives at these results are 
quite elaborate, and are no doubt correct. It 
will be observed that his statement was made 
fifteen years ago, and it applied only to Great 
Britain and the United States. Since that time 
this operation has extended all over the civil- 
ized world : and it would be a difficult matter 
to compute the many thousands of years vouch- 
safed to woman by this operation. In one of 
the earlier editions of Diseases of Women, Dr 
West thus writes ■ " I think, then, that we are 
now bound to admit 'ovariotomy' as one of 
the legitimate operations in surgery ; as hold- 
ing out a prospect, and a daily brightening 
prospect of escape from a painful and inevitable 
death, which at last, indeed, becomes welcome, 
only because the road that leads to it conducts 
the patient through such utter misery." 

Lord Selborne, one of the most distinguished 
of the British Chancellors, speaking at the 
opening of the Dorset House Branch of the 
Samaritan Hospital for Women in 1875, said, 



OVARIOTOMY. 21 5 

" The work done by the hospital he regarded 
not only with satisfaction but with admiration, 
for it represented one of the most splendid 
triumphs of modern surgical art and modern 
philanthropy, one of the greatest achievements 
of medicine or of surgery in any age. Until a 
few years since, this kind of disorder had been 
regarded as necessarily and absolutely fatal, 
and as reducing the reasonable possibility of 
life in the woman afflicted by it to four years, 
though the duration of life generally fell far 
short of that. Instead of the four years of 
declining health and hopeless misery which 
those women would have had to anticipate, not 
only those four years, but twenty-five years, 
which, upon the average, had been wholly 
saved to them, were years of restored health, 
usefulness, and happiness to those who had 
been benefited by the operation. He thought 
the man of whom that could be said, and the 
art of which it could be said, deserved higher 
honors, higher reward, and higher praise than 
most things which it was permitted to any man 
or any art in this world to be able to do." 
J* If there was ever a public benefactor, surely 
\ it was your illustrious grandsire, Ephraim 
McDowell, who, on that cold December morn- 



2 i6 OVARIOTOMY. 

ing, in the year 1809, on the person of Mrs. 
Crawford, who must have been necessarily 
fatigued by a journey of sixty miles on horse- 
back, with the protuberant abdomen bruised 
by contact with the horn of the saddle, gave to 
the world and to mankind, by his courage and 
his skill, this brilliant and beneficent operation. 
It was the dawn of a new era in surgery, and 
its beneficence is not confined to ovariotomy 
alone. But for its successful inauguration, 
would Simon, of Heidelberg, in 1869, have ever 
dared to extirpate the kidney on a living sub- 
ject? Would Billroth, of Vienna, have had 
the courage, with all his dash and brilliancy as 
an operator, to exsect the human stomach for 
cancer ? Would laparotomy for the control of 
hemorrhage and the closing of wounds in the 
intestines occasioned by leaden missiles be a 
recognized and legitimate operation of the day? 
Would not those unfortunates suffering from 
uterine fibroids be abandoned to their fate ? and 
would not our own Battey have hesitated ere 
he performed the operation which bears his 
name, had not the immortal McDowell pre- 
ceded him in a hitherto unknown field ? 

But to proceed to the operation: and here 
allow me to remark/ that courage and confi- 



wm 



OVARIOTOMY. 21/ 

dence on the part of the patient are impor- 
tant elements of success. The most favorable 
view of her case, consistent with truth and 
veracity, should be presented to her, and every 
proper means taken to help her to expect re- 
covery, instead of leaving her mind in doubt 
and uncertainty. Preparatory measures should 
be instituted to secure a healthy action of the 
liver, kidneys, and skin. To this end the bowels 
should be emptied of all accumulations by gen- 
tle cathartics, the renal organs increased in 
activity by the administration of proper diu- 
retics, and the cutaneous organs stimulated by 
hot baths, followed by friction over the surface 
of the body. Sleep should be induced by the 
administration of the bromide of potassium or 
of chloral hydrate, and on the morning of the 
operation the intestines should be opened thor- 
oughly by a large enema of hot water, in which 
one or two tablespoonfuls of salt have been dis- 
solved. A bright, clear day is preferable, but 
when the operation has been fixed for a certain 
hour (I prefer to operate at 1 1 a.m.) it should 
not be postponed on account of bad weather. 
The best place for the operation is at the home 
of the patient, provided quiet and cleanliness 
and good ventilation can be obtained. Private 



I 



21 8 OVARIOTOMY. 

hospitals, where good attention is always at 
hand, is the next best place, and perhaps 
equally as good as the home of the patient. 
A large general hospital is the last place / 
would select in which to do an ovariotomy. 
The dress of the patient at the time of the 
operation should consist of woollen underwear, 
drawers and stockings, together with a muslin 
nightgown, and during the operation as little of 
the surface of the body as possible should be 
uncovered ; the additional precaution being 
taken to wrap the lower extremities in a wool- 
len blanket. The operating table should be 
five feet long, and twenty inches wide, and 
high enough to enable the operator to 
stand erect ; it should be placed near a 
large window, and yet so that all may pass 
around it with ease. It should be covered 
with two or three comfortables, over which are 
spread a clean muslin sheet and a rubber or oil 
cloth. The personal preparation of the sur- 
geon, his assistants and the attendants, is a 
matter of paramount importance ; perfect clean- 
liness, which is next to godliness, should be 
rigidly insisted upon. On the day of the opera- 
tion they should not be engaged in dressing 
wounds or in attending any infectious disease. 



OVARIOTOMY. 219 

Their clothing should be scrupulously clean, 
their hands should be washed in carbolized 
water, and the finger-nails carefully cleaned. 
And here it is proper to remark, that on no 
account should an assistant, during the opera- 
tion, be permitted to place his hand in the 
abdomen of the patient, except on invitation of 
the chief operator. Everything being in readi- 
ness the patient should be thoroughly anaesthe- 
tized, and while this can be accomplished by 
ether or chloroform, yet I am an enthusiastic 
advocate of bichloride of methylene, adminis- 
tered in a Junker's inhaler, not only in all my 
ovariotomies, but in many other grave opera- 
tions. I was led to its use by seeing with what 
ease and safety anaesthesia was induced and 
maintained by it in the Free Samaritan Hos- 
pital, in London, and also in some of the pri- 
vate operations of Sir Spencer Wells, who, in 
1877, said, "that after ten years' experience of 
its use, in more than one thousand cases, he 
believed it to be, without a single exception, 
applicable to every patient, perfectly certain to 
produce complete anaesthesia, relieving the 
surgeon from all alarm and even anxiety, and 
its use has never been followed by any danger- 
ous symptoms which could be fairly attributed 



220 OVARIOTOMY. 

to it." I have now used it in over two hun- 
dred operations of various kinds, and my ex- 
perience tallies with the above in every par- 
ticular, and I have yet to meet with a single 
untoward symptom arising from it. After the 
patient has been anaesthetized she should be 
placed on the operating table, with her feet 
toward the light, her wrapper drawn up under 
her arms, and the abdomen covered with a 
light rubber blanket, having an opening eight 
or ten inches in length, and of sufficient width 
to permit an easy exposure of the most promi- 
nent part of the abdomen. The surgeon takes 
position on the right side of the patient, and 
places his first assistant immediately opposite. 
The instruments should, be within easy reach, 
and be placed in a shallow earthenware dish 
(that used by photographers is the best) con- 
taining a i : 40 carbolic acid solution, and be 
arranged as nearly as possible in the order in 
which they are likely to be required. The 
operation may be divided into three stages : 
1. The exposure of the tumor. 2. Its re- 
moval. 3. Cleansing the peritoneal cavity, 
"toilet of the peritoneum," and closure of 
the ventral wound. To accomplish this the 
following instruments will be needed : one seal- 



OVARIOTOMY. 2 2I 

pel, one straight probe-pointed bistoury, one 
tenaculum, one Keyes's director, one pair dis- 
secting forceps, one artery forceps, one dozen 
pairs bow-torsion forceps, one No. 10 steel 
sound, one Sir Spencer Wells's omentum 
clamp, two pairs vulsella, two pairs Nelaton's 
forceps, one Wells's needle-holder, one cautery 
clamp, one sponge-holder, twelve veterinary 
needles, straight and curved ; besides at least 
twelve soft cup sponges, three spools of Jap- 
anese cable silk, Nos. i, 2, and 3 ; silkworm 
gut ; one broad flat potter's sponge ; and it is 
also well to have a Paquelin's thermo-battery 
at hand for charring the pedicle. 

The incision should be made exactly in the 
median line, midway between the symphysis 
pubis and the umbilicus ; in doing this we may 
cut freely through the skin and adipose tissue 
immediately beneath it, which will expose the 
aponeurotic expansion of the abdominal mus- 
cles. Now, with the tenaculum, lift up a thin 
layer of this aponeurosis, and divide it on the 
Keyes's director. If we are not exactly in the 
median line, the edge of the rectus muscle will 
come into view ; should this be the case, the 
lined alba may be found by passing the handle 
of the scalpel first to one side and then to the 



222 OVARIOTOMY. 

other, when the edge of the muscle will be 
encountered. By very light strokes with the 
knife we divide the tissues until we come down 
upon the thin and loose cellulo-adipose tissue 
which lies just external to the peritoneum. 
Bleeding should be controlled by the applica- 
tion of a bow-torsion forceps to every point 
which requires it. After all hemorrhage has 
ceased, the peritoneum should be raised on the 
point of the tenaculum, and divided to such an 
extent as will admit of the introduction of the 
Keyes's director upon which it is to be divided 
the extent of the incision. The steel sound 
should now be introduced between the sac and 
the abdominal walls, and swept around slowly 
and gently, to detect the presence or absence 
of adhesion over the anterior portion of the 
tumor. If no adhesions are found, the large 
Wells's trocar, with the rubber hose attached, 
should now be plunged into the sac at the 
upper angle of the wound, and the fluid allowed 
to flow through the tubing into the vessel placed 
for its reception under the table. As the 
tumor decreases in size, the sac should be 
seized with the vulsellum or Nelaton's forceps, 
or both, and drawn forward on the canula, to 
prevent the fluid from entering the cavity of 



OVARIOTOMY. 2 2X 

the abdomen. This part of the operation may 
be much facilitated by judicious pressure upon 
the abdominal walls by the hands of one of the 
assistants. If the sac is unilocular it can be 
entirely emptied through a single puncture. 
If the sac is multilocular the trocar should be 
passed from the primary puncture of the main 
cyst into each presenting cyst successively, 
until all are emptied and the tumor be reduced 
to such size that it can be brought out through 
the incision. If the contents of the sac are so 
viscid or solid as not to be able to pass through 
the canula, a large opening must be made in 
the sac, and the hand introduced as a scoop to 
remove them. The cyst. is then drawn through 
the opening and brought through the outside 
of the body, which exposes the pedicle. Of 
course, all adhesions must be carefully sepa- 
rated and all bleeding points ligated. On the 
subject of securing the pedicle, ovariotomists 
are not agreed. The most common methods 
are the clamp, the ligature, the cautery, and 
the ecraseur. I prefer the ligature or the cau- 
tery. If the ligature is used, the pedicle should 
be transfixed by a large aneurism needle, and 
tied in two or three sections, with the Japanese 
cable silk ; the tumor cut away three-quarters 



OVARIOTOMY. 



of an inch from the ligature, and the stump 
dropped back into the abdomen. 

In using the cautery, the method which I 
greatly prefer, the pedicle is tightly embraced 
in the cautery clamp, two small folded towels 
wrung out of cold water being placed under it, 
next the abdomen. The tumor is then burned 
off external to the clamp and the iron (Pa- 
quelin thermo-cautery, I use) at a dull red 
or black heat, is passed over the stump 
slowly and steadily for several minutes, until it 
is entirely charred — " mummified," if you please 
so to call it. The danger in using the cautery 
only consists in using an ill-constructed clamp, 
having the cautery iron at too high a heat, and 
the operator being in too great a hurry. 

The most painstaking care should be exer- 
cised in the search for bleeding points, each and 
every one of which should be controlled by a 
ligature of fine silk. Blood, serum, or ovarian 
fluid should be carefully sponged out of the 
cavity until it is absolutely dry ; and before 
closing the external wound, the ligatures should 
be cut short and the uterus and the stump of 
the pedicle be placed below the intestines in 
their normal position. In closing the external 
wound, various articles may be used, such as 



OVARIOTOMY. 



225 



silk, silver wire, iron wire, etc. But in my 
opinion silkworm-gut is the ideal suture. I am 
indebted to Dr. George Granville Bantock, of 
London, for the idea of its use. It is hard, 
round, smooth, and unirritating, and can be 
rendered perfectly aseptic by placing it in the 
solution the day before it is required for use. 
It is obtained by taking the cocoons, about the 
time they are ready to spin, and steeping them 
in dilute acetic acid, when they become a soft, 
pulpy mass ; it is then " drawn" like silver wire. 
In all gynecological operations, nothing can 
exceed this suture for safety, the facility with 
which it can be introduced, or the ease and 
slight disturbance of the line of union in its 
removal. 

The " toilet of the peritoneum " being com- 
plete, the flat potters sponge should be intro- 
duced into the abdomen immediately under the 
ventral wound to absorb any blood which might 
trickle down from the punctures made by the 
needle. Two veterinary needles should be 
" threaded" on a strand of silkworm-gut; the 
needle taken in the grasp of Spencer Wells's 
holder, and should be introduced from within 
the wound, and should pass through the peri- 
toneal, muscular, and cutaneous tissues ; the 
15 



22 6 OVARIOTOMY. 

needle is now detached, and the end of the 
suture given into the hands of an assistant; the 
other needle is next introduced and passed in 
the same manner upon the opposite side of the 
wound, so that the suture will inclose all the 
parietal layers — these sutures should be placed 
less than an inch apart, and it is well to require 
every sponge and instrument which has been 
brought into the operating room to be accounted 
for before closing the wound. The flat sponge 
should now be removed and the sutures tied. 

However, should it be evident or probable 
that oozing of blood or serum, or of both, will 
go on after closure of the external wound, and 
especially when there has been an escape of 
ovarian fluid into the peritoneal cavity, drain- 
age will be demanded. This is best accom- 
plished by the use of the glass tube of Dr. 
Keith, now of London. After introducing all 
the sutures, Douglas's pouch is finally cleaned 
out, and while with the left hand the intestines 
are kept out of the way, the fingers serving as 
a guide to the tube, it is passed down to the 
bottom of the pouch between two of the sutures, 
and in such a manner that the tube maintains 
a perpendicular position, after which the suture 
may be tied. A cup sponge wrung out of a 



OVARIOTOMY, 



227 



one to twenty carbolic acid solution should be 
placed over the external end of the tube and 
the dressing completed. The drainage-tube 
will seldom be needed longer than the fifth or 
sixth day, but in that time many ounces maybe 
removed by the glass syringe over the nozzle 
of which is drawn a piece of rubber tubing. In 
the after-dressing several wide strips of adhe- 
sive plaster should be placed across the abdo- 
men, over a piece of " protective " sufficiently 
large to cover every part of the wound. 

Over this should be applied large flannel 
compresses three or four inches thick, and the 
whole should be encased by a broad flannel 
binder, extending from the pubes to the ensi- 
form cartilage ; after which the patient may 
be placed in bed, the operative procedure being 
completed. 



CHAPTER XIV. 

MCDOWELL'S OPERATION OF OVARIOTOMY BY THE 
LONG INCISION DURING THE FIRST THIRTY- 
THREE YEARS OF ITS EMPLOYMENT, 
WITH COMMENTS. 

By Nathan Bozemax, M.D., New York City. 



Introduction. 1 

In my somewhat extended title I present at 
once to the reader a broad field of study and 
investigation upon seemingly an old subject, 
and the question will no doubt be as promptly 
asked, what there is new or profitable to be 
learned from previously reported and well 
stated facts pertaining to an operation so thor- 
oughly well understood at the present time as 
that of ovariotomy ? I might answer this ques- 
tion by asking another : Have all the facts con- 
nected with the origin and development of this 
truly useful and universally accepted operation 
ever been brought out in the order of their 
chronological importance and significance, as 

1 Read before the New York County Medical Association, 
May 19, 1890. 
(228) 



MCDOWELL'S OPERA Tl ON. 229 

their merits have entitled them to be, and the 
claims of the "Father of the Operation" de- 
manded ? 

But I do not content myself by simply an- 
swering a question of justice or sentiment, the 
genuineness of the latter having already been, 
as it will continue to be to the end of time, fully 
appreciated by mankind. This sentiment is, as 
yet, embalmed in the memories of his profes- 
sional brethren for scarcely two generations, 
and the remains of Ephraim McDowell are but 
freshly deposited, as it were, in the tomb at 
Danville (the theatre of his surgical achieve- 
ments) — a silent though significant reminder of 
the ending of a truly great and useful life, and 
the important incidents connected with it. Here 
in this beautiful little town of Kentucky, near 
the homes and resting-places of his contempo- 
raries, Dudley, the greatest of lithotomists, and 
Clay, the most eminent among statesmen, a 
grateful profession, which he while living so 
much adorned, has erected a monument to the 
memory of McDowell, to perpetuate not only 
his honored name, and his noble, generous, and 
well-spent life, but the transcendent value and 
acknowledged influence of his labors in benefit- 
ting mankind. Let each succeeding generation 



230 MCDOWELL'S OPERATLON. 

of physicians, therefore, acknowledge and treas- 
ure the inestimable advantages it has derived 
from these labors. 

My contribution in regard to the acknowl- 
edged and appreciated benefits arising directly 
from the labors of McDowell, the " Father of 
Ovariotomy," is based upon an existing and 
long-felt necessity of a presentation in chrono- 
logical order of all the facts pertaining not only 
to the histories of McDowell's own cases and 
operations, but to those of his immediate fol- 
lowers in this country and in Europe, during 
the formative stage, so to speak, of his proce- 
dure by the long incision (1 809-1 842). This 
mode of studying and bringing out in detail the 
salient points of his experience and that of his 
successors, as I propose to do in this contribu- 
tion, has never before been followed, so far as 
I am aware, further than by statistical tables, in 
which circumstances, histories, and peculiarities 
of cases have been almost entirely ignored; 
and dates, figures, and death-rates (even these 
sometimes being vague, unintelligible and use- 
less) made to take their places with the seeming 
intent in some instances to prove to the inex- 
perienced physician the dangers and uncertainty 
of the procedure, rather than to encourage the 



MCDOWELL'S OPERATION. 2 $I 

hesitating and faint-hearted, by making clearer 
by well-digested principles and facts, the way 
to success. 

In the outset it is proper to point out the 
names of surgeons that have been made to pre- 
cede that of McDowell in the tables of statistics 
referred to. They are Houston, L'Aumonier, 
Dzondi, and Galenzowski. All, excepting the 
latter, were connected with the old method of 
incision (incisionism, if I may be pardoned for 
using the term), in which procedure extirpation 
of the diseased ovary was not even thought of. 
For example, in the tables of Dr. Samuel J. 
Jeaffreson, and of Dr. Fleetwood Churchill 
(1844), L'Aumonier is made to take prece- 
dence of McDowell, as a successful ovarioto- 
mist, whereas he had simply succeeded by 
incision in emptying a pelvic abscess, presenting 
six or seven weeks after parturition. Again, in 
the table of the late Dr. W. L. Atlee, 1 in addi- 
tion to the name of L'Aumonier, those of 
Houston, Dzondi, and Galenzowski, are all 
made to precede that of McDowell, each in 
the achievement of a success by ovariotomy, 
whereas neither Houston nor Dzondi had the 

1 A Table of all the Known Operations of Ovariotomy, from 
1701 to 185 1. Trans, of Am. Med. Asso., 1851. 



232 MCDOWELL'S OPERATION. 

slightest conception of extirpation of the ovary; 
the former having cured his case by the old 
method of incision and a tent, and the latter, 
whose case happened to be an encysted dropsy 
of the abdomen, in a boy twelve years old, 
effected his cure likewise by incision, tent, and 
forceps. As to the third case referred to — that 
of Galenzowski, of Wilna, West Russia, it was 
simply an unfinished ovariotomy, performed in 
accordance with the procedure of McDowell by 
the long incision, eighteen years (1827) after 
the first operation of the latter. The operator, 
finding it impossible to remove the tumor on 
account of the numerous and strong adhesions 
found to exist, emptied the cyst by breaking up 
its contents with his hands, and then effected 
an outlet for drainage through the closed ab- 
dominal wound, thus curing his patient, just as 
any follower of McDowell would do at the 
present time under similar circumstances, and 
would reasonably expect a like result. 

Mr. Benjamin Phillips, of England, in his table 
of statistics (1844), places the name of McDow- 
ell at the head of the list of operators, acknowl- 
edging him as the first to perform ovariotomy. 
M. Chereau, of France (1844), not only does 
the same thing, but takes occasion to say that 



MCDOWELLS OPERATION. 233 

he excludes the case ot L'Aumonier (his own 
countryman) from the list of successful ovariot- 
omies, in which it had previously been errone- 
ously included by other writers, for the reason 
that the disease for which L'Aumonier per- 
formed his operation "was abscess of the 
ovary," and that if he excised the ovary, as had 
been claimed for him, he did it by chance or 
accident, and not from any preconceived plan 
of the necessity of such a procedure. 

The late Prof. S. D. Gross also discovered 
the great injustice to the claims of McDowell, at 
home and abroad, in the statistical tables particu- 
larly referred to, and from neglect and careless- 
ness of acknowledgment in other ways, and 
determined to bring out, as far as possible, all 
the facts relating to the cases and operations of 
McDowell, which he did in his " Report on 
Kentucky Surgery" (the State in which he re- 
sided at that time), presented at the annual 
meeting at Louisville of the State Medical So- 
ciety, October, 1852. 1 This was really the first 
decisive defence of the claims of McDowell that 
had ever been made up to that date. Dr. Gross 
took strong grounds regarding the absurdity of 
the importance that previous writers had given 

1 Gross on Kentucky Surgery, 1852. 



2^4 MCDOWELL'S OPERATION. 

to the cases of L'Aumonier, Dzondi, and Galen- 
zowski, and adduced the most cogent arguments 
to prove that the results in these three cases, 
especially, had not the slightest claims of recog- 
nition as successful ovariotomies. The result 
was that after the date of Dr. Gross's compre- 
hensive and convincing contribution upon the 
subject, writers of all countries came to look 
upon the claims of McDowell in the same light, 
and recognized the just value of his labors in 
giving to the world ovariotomy, founded upon 
correct principles of success, whatever the 
method of performing it, whether by long in- 
cision or short incision. 

Dr. Atlee, after the appearance of Dr. Gross's 
able defence, became thoroughly convinced of 
his error in references, and the wrong thereby 
done the claims of McDowell by having placed 
his name fifth, instead of first, in his table of 
statistics, and afterward proved the sincerity of 
his convictions of injustice upon this point by 
dedicating his able work 1 in these words: "To 
the memory of Ephraim McDowell, M.D., of 
Kentucky, the Founder of Ovariotomy in 1809 ; 
and to John L. Atlee, Sr., M.D., of Pennsyl- 
vania, my Brother, Preceptor, and Friend, who 

1 Ovarian Tumors, 1873. 



MCDOWELL'S OPERATION. 235 

since 1843 has Aided in Establishing this Ameri- 
can Operation, I Dedicate this Volume, the 
Fruits of my Experience and Observation." 

My object in the study of McDowell's opera- 
tion of ovariotomy is to present the experience 
of every surgeon (in his own words as far as 
possible) in a chronological order, as the cases 
are found recorded, commencing with those in 
the United States ; then taking up those in 
France, including here in my discussion of the 
subject a short sketch of the old method of in- 
cisionism ; next those in Germany, and finally 
those in Great Britain ; the four countries, only, 
in which any considerable attention was given 
the operation up to the time of its revival in 
England by Dr. Charles Clay, of Manchester, 
in 1842, and in the United States, by the late 
Dr. John L. Atlee, of Lancaster, Pennsylvania, 
in 1843. 

But the plan here proposed of collecting the 
facts in the record of cases, as found published 
in the medical literature of the several countries 
named, is not alone sufficient to enable us always 
to seize upon the distinctive features of the pro- 
cedure employed; and a more direct way of 
discriminating between the real principles of the 
operation of McDowell, and a modification of 



236 MCDOWELL'S OPERATLON. 

them, is called for. The most important prin- 
ciples are extirpation of the ovary, his long 
incision, and the bringing out at the lower 
angle of the wound of the two ends of the liga- 
ture on the pedicle ; though there is abundant 
evidence to prove, from the histories of his 
cases, that he also employed the medium and 
short incisions, when necessary, as well as direct 
ligatures to individual arteries in the pedicle, 
omentum, or other parts, and even cut off the 
ends of the latter close to the knots in some 
instances. 

Now, to understand and appreciate the im- 
mense and important advance made by Mc- 
Dowell in the employment alone of his long 
incision into the upper division of the abdomen, 
reaching from the ribs to the pubes, whether 
outside of the recti muscles or in the linea alba, 
it will be necessary to glance at the old method 
of incisionism, without any regard to the re- 
moval of the ovary. Here, the incision was 
always made below a line stretching trans- 
versely across the abdomen at the umbilicus, 
for the reason that the disease was believed to 
be of a scirrhous character, the origin and seat 
of which were at or near the base of the tumor 
in the pelvis, or in one or both of the iliac fossae. 



MCDOWELLS OPERATION. 2 -\7 

With this view of the pathology of ovarian 
dropsy at the early period of which we are 
speaking, there existed a knowledge among the 
incisionists generally that the seat of the disease 
in whichsoever ovary could be recognized in 
its early stage ; but at a more advanced stage 
of the disease, when the enlargement occupied 
both sides of the abdomen, the actual seat of 
its origin could not be accurately determined ; 
hence the importance insisted upon by them of 
performing the operation early, before the en- 
larging tumor had reached the umbilicus. From 
this arose the custom of always making the 
opening below the umbilicus. The operator 
consequently was influenced by the point of 
greater prominence in the affected side, without 
regard to the direction of the line of his incision, 
whether across the fibres of muscles or the linea 
alba or the course of arteries. For example, 
Dr. Robert Houston, of Great Britain, found 
in his case the tumor to occupy the left side, 
extending up to the umbilicus, and he pro- 
ceeded to make his incision over the most 
prominent point of it : first, one inch, then ex- 
tending it to three, and finally to five inches, 
laying open, as he proceeded, the dropsical 
ovary. This he did in 1701, though the result 



238 MCDOWELL'S OPERATION. 

was not published until 1724, as will be seen 
later on, and I believe it to have been the first 
operation by incisionism ever performed. 

Le Dran, in France, began and completed 
his observations and experience in connection 
with incisionism between the years 1736 and 
1746. His first operation, as described, was 
in the case of a tumor in the left side, but a 
puncture had been made in the right side by 
the physician previously in charge, since, from 
the size of the tumor, he was unable to decide 
the seat of origin. Here Le Dran made his 
incision, from the puncture in the right side 
downward, four inches in length, and large 
enough to admit two fingers ; but, not finding 
the tumor on this side, he was led, several 
months later, to make a transverse incision 
from the point named to the left side, about 
four fingers' breadth above the pubes, cutting 
across the muscles and arteries, to the extent 
of six to seven inches. He then introduced his 
hand for exploration. In his second case he 
made a medium incision in the linea alba, ex- 
tending from the umbilicus to the pubes ; his 
object being in this instance to guard against a 
prompt closure of the abdominal wound, and to 
favor the contraction of the cyst by inflamma- 



MCDOWELL'S OPERATION. 239 

tion and suppuration of its walls, induced by 
the use of a tent or drainage tube with injec- 
tions, thus keeping all the while the outlet of 
the cyst near its bottom — the scirrhous seat of 
the disease. 

Delaporte, a few years later, doubtless a fol- 
lower of Le Dran, found a semi-solid tumor fill- 
ing the entire abdomen, but was influenced by 
the greater prominence of the left side, to make 
his incision there. It was four inches in length, 
and the same opened up the tumor. The re- 
sult was, so great was the flow of the con- 
tained gelatinous fluid, that no further attempt 
was made at exploration for several days, and 
even then to no effect, since we are told that 
the flow continued more or less free until the 
eleventh day, when the patient expired. It was 
from the autopsy in this case that he discovered 
the actual seat of the disease to be in the right 
ovary instead of in the left. From these obser- 
vations, and much to his credit, he made the 
first suggestion or proposal "to remove the 
focus of the disease — namely, the tumor formed 
by the ovary." 

When Delaporte suggested the possibility of 
removing "the focus of the disease" in the 
ovary, he was no doubt overawed by the enor- 



240 MCDOWELL'S OPERATLON. 

mous size of the multilocular cyst he had just en- 
countered, and fully impressed with the utter 
impossibility of any one determining beforehand 
the particular ovary involved in such a case. 
He, therefore, made the proposal credited to 
him, under the conviction that if it were ever 
executed, it would have to be done when the 
disease was in its early stage. All incisionists 
insisted upon this early attention to the state of 
the tumor ; and even Morand, in commenting 
upon the cases of Le Dran and Delaporte, em- 
phasized the importance of this precaution, even 
stating that if the latter had acted upon this 
principle and operated earlier, the result in his 
case might have been different. 

Incisionism, including tent and drainage-tube 
with injections, for the cure of dropsical ova- 
ries would seem to have reached the limit of 
popularity with Delaporte's case, and his sug- 
gestion of the preferableness of removing the 
organ itself, "the focus of the disease," which 
was about or just after the middle of the cen- 
tury (1750). Nevertheless, the practice con- 
tinued to receive more or less attention. 
Theden, of France, soon after Delaporte's pro- 
posal, projected the plan of an operation com- 
bining with incisionism the latter's suggestion 



MCDOWELL'S OPERATION. 24 1 

of the removal of the ovary. This he proposed 
to do by a short incision in the inguinal region, 
based upon the idea that the diseased ovary 
here was outside the peritoneum. After ex- 
posing the ovary, and giving vent to the con- 
tained fluid, he would finish by drawing out the 
sac and putting a ligature upon its point of 
attachment, leaving both ends of the latter 
hanging out of the wound. If the organ were 
found hardened he would bring- it out with his 
fingers, putting the ligature on to cause its 
destruction. According to circumstances he 
would tighten the ligature, but to prevent acci- 
dent he would amputate the ovary. This 
scheme, such as it was, of associating the old 
method of incisionism in the lower division of 
the abdomen with the removal of the ovary in 
the way just pointed out, was at the time ex- 
tolled by Morand, and discussed and com- 
mented upon with great enthusiasm by Power 
and Darwin, of England. 

From these notices and recommendations of 
the proposal there is reason to believe that 
Dr. Wm. Hunter, as we shall see in the English 
history of the subject, was led, in 1757 (familiar 
with incisionism), to make his very pertinent 
remarks upon the pathology of dropsical cyst 



242 MCDOWELL'S OPERATION. 

of the ovary and the suggestion of a method 
by which the tumor, composed of one or two 
small cysts, could be exposed by a small inci- 
sion, admitting " two fingers or so," punctured, 
drawn out, and excised. There is no evidence, 
however, to show that either the recommenda- 
tions of Theden or his own were ever put into 
practice in France or England. 

L'Aumonier's operation, performed in 1782, 
as will be pointed out at length in the French 
history of the subject, was unquestionably an 
extension of the old method of incisionism, and 
the claim of removal of the ovary is here made 
very much as described by Theden, except that 
no mention is made of a ligature ; though the 
facts do not warrant such a claim to success, 
the case having been one of simple pelvic ab- 
scess relieved by puncture. 

M. d'Ischier in his inaugural thesis (Theses 
de Montpellier, 1807) endeavored to maintain 
L'Aumonier's claim of successful removal of 
the ovary in the operation referred to, though, 
according to the high authority of Prof. Vel- 
peau, he failed to do so. 

Thus, from all that has been said of incision- 
ism, extending for a period of 108 years up to 
the time of McDowell's operation, 1809 — it is 



wm 



MCDOWELL'S OPERATION. 243 

clear that the oreneral rule of the incisionists 
was to make the opening into the abdomen 
below the umbilicus, with the idea of curing the 
dropsical cyst by causing inflammation and 
suppuration of the walls of the same by injec- 
tions and drainage. The safety of making inci- 
sions in several directions into the lower divi- 
sion of the abdomen was certainly proved by 
Houston and Le Dran ; while of the proposal 
made by Delaporte of removal of the ovary, 
there seems to be no doubt, with also a fair 
show of probability, that Theden, in the plan 
projected by him of an operation for removal 
of a dropsical ovary, understood the necessity 
of employing a ligature on the pedicle to pre- 
vent hemorrhage. 

Whether Dr. McDowell knew anything 
about this previous work of incisionism as 
applied to the lower division of the abdomen, or 
of Hunter's proposal of removal of the ovary 
by a short incision, or of the employment of a 
ligature on the pedicle, no one can positively 
say. It is well known, however, that he was a 
student of medicine in the University of Edin- 
burgh, and a pupil while there of the celebrated 
Mr. John Bell (1793-94), who was thoroughly 
well informed in everything that related to sur- 



244 MCDOWELL'S OPERATION. 

gery. The natural inference, therefore, is that 
the pupil, known to have been a close and dili- 
gent student, became interested in the question 
of incisionism and the proposed extirpation of 
the ovary, as taught at that period, and gave 
the subject more than ordinary attention. Be 
this as it may, certain it is that the brilliant and 
instructive lectures by Mr. Bell, listened to by 
McDowell, gave no encouragement to a hope- 
ful outlook as to any future development of the 
operation in question, since not a single exam- 
ple of extirpation of a diseased ovary had taken 
place in any country up to that date, or did occur 
up to the time of McDowell's conception and 
first performance of such an operation in 
December, 1809. 

When, therefore, McDowell made his long 
incision, extending into the upper division of 
the abdomen, from the margin of the ribs or 
ensiform cartilage to the pubes, he did what no 
other operator had ever done or thought of 
before, and by so doing was the first to " remove 
the focus of the disease ; namely, the tumor 
formed by the ovary," as casually suggested by 
Delaporte some sixty years previously ; thus 
instituting a new departure, original and com- 
plete. By the same step and at the same 



MCDOWELL'S OPERATLOX. 245 

time was associated with this long incision (but 
little, if any, less important) the fullest ex- 
ploration possible for the discovery of " the 
focus of the disease — the tumor formed by 
the ovary," as well as the complications pre- 
sent, of whatsoever gravity or extent, whether 
above or below the umbilicus. 

McDowell's boldness and his advance upon 
incisionism are to be found mainly in these 
three steps : namely, the long incision reaching 
into the upper division of the abdomen, the 
widest exploration possible of the peritoneal 
cavity, and the successful extirpation of a drop- 
sical ovary. The fact of his having only empha- 
sized the long incision in his first trial of it, does 
not prove by any means that he was ignorant 
of the advantages of the short and medium 
incisions in the lower division of the abdomen, 
since he proved the contrary in his published 
cases ; that he employed both of these forms of 
incision, first for the introduction of the finger 
into the abdomen, and second of the hand, alike 
for explorative and operative purposes. 

It is proper to mention in this connection the 
error of a few of McDowell's immediate fol- 
lowers, who, supposing that he was not familiar 
especially with the use of the short incision, 



246 MCDOWELL'S OPERATION. 

thought (no doubt honestly) that they had made 
an improvement in practising it ; some of them 
even claiming originality in the employment of 
this form of incision, restricted to the limits of 
one to four inches. Among these surgeons 
were Dr. Nathan Smith, in the United States, 
and Messrs. Jeaffreson, King, West, Phillips, 
and several others in England. The results of 
their operations by this short incision proved, 
as is well known, unfortunate both for their 
claims of improved success and for science, 
since the dangers incident to the trial of the 
procedure could only be determined by a con- 
siderable number of cases, and this consumed 
four or five years. Thus was the general ac- 
ceptance of McDowell's procedure by his long 
incision delayed, and the development of its real 
merits prevented, much longer than would 
otherwise have been the case. 

The question of the defectiveness of the short 
incision was no doubt fully settled in the mind 
of McDowell before he ever decided upon mak- 
ing his long incision, as proved by the extra- 
ordinary boldness with which he carried the 
plan of the latter out in his first case, and the 
persistent employment of it afterward in one or 
two of his cases, where the medium incision 
would have answered just as well. 



MCDOWELL'S OPERATION. 2 tf 

It was, therefore, the utter failure of the short 
incision, as employed by the surgeons named, 
to furnish the requisite scope and facilities for 
exposure of the tumor and for manipulation in 
the abdomen, except in simple and uncompli- 
cated cases, that the wider range of application 
of McDowell's long incision came finally to be 
seen and appreciated. With this revulsion of 
feeling on so important a point there was a 
cessation in the employment of the short incision 
just after the disastrous result that followed 
Mr. Benjamin Phillips's operation (1840), from 
hemorrhage caused, no doubt, by the dragging 
of the collapsed cyst walls through an abdomi- 
nal opening too small, and the laceration of the 
broad ligament or some other unduly-exposed 
structure. It was due to such consequences 
and the utter inability of the advocates of the 
procedure to answer such a potent objection as 
this and others that might be adduced, that the 
attention of the profession was directed anew 
to the superior advantages of the McDowell 
procedure by the long incision. This renewed 
investigation led to the revival of his operation, 
and in this movement, as previously mentioned, 
Dr. Charles Clay, of England, was foremost. 

The distinctive advantages of McDowell's 



248 'MCDOWELL'S OPERATIOX. 

long incision as compared with the short incision, 
therefore, may again be repeated as follows: 
The laying open of the entire abdomen ; the 
exposure of the tumor in whatsoever stage of 
its growth ; the searching for and overcoming 
of adhesions ; and the guarding against injury 
to the surrounding organs. The association of 
these principles, as shown in the reports of 
McDowell's first five cases (1809-18 19) gave 
him three successes out of four completed 
operations. One operation was unfinished on 
account of the existence of a sessile fibrous 
growth of the uterus ; and in this case the pa- 
tient recovered. This is a degree of advance- 
ment in diagnosis and the achievement of prac- 
tical results from the procedure by McDowell 
himself that can be but little, if at all, surpassed 
by the majority of operators at the present day. 
As to what has now been said in condemna- 
tion of the short incision for the extirpation of 
dropsical ovaries of the semi-solid character, and 
even of the simpler forms complicated with 
extensive adhesions, I may be permitted here to 
add that the same general principles underlying 
the employment of the long incision apply with 
almost equal force to the importance of discrim- 
inating between the range of adaptation of the 



MC DO WELLS OPERA TION. 



249 



short and the medium incisions, restricted, as in 
the days of old incisionism, to the lower division 
of the abdomen. This view of the subject, with 
regard to pathology and diagnosis, I believe to 
be strictly correct, not only for the removal of 
simple or multiple cysts of palpable size, but 
(as in laparotomy of to-day) for operations for 
" deep-seated pelvic pains," for "pus tubes," or 
for "fixed" or "cystic ovaries" of impalpable 
size, having whatsoever " focus of disease" or 
complications, and sometimes requiring, as 
alleged, one or more repetitions. 

A typical example of the superior advantages 
of the long incision of McDowell, as illustrated 
in the case 1 of a large semi-solid tumor (multi- 
locular) which I operated upon in Coosa County, 
Alabama, a little over a quarter of a century 
ago (January 14, 1865), I will introduce here in 
further contrast of what has already been 
brought out in regard to the short incision. 

This patient had previously been tapped 
seven times, and the aggregate of fluid drawn 
off was computed at thirty-five gallons. The 
tumor occupied the entire abdomen and part of 
the pelvis, with considerable protuberance to 
the left and just below the umbilicus, and the 

1 N. Y. Med. Record, Sept. 1, 1866. 



250 MCDOWELL'S OPERATION. 

subcutaneous veins over the abdomen were 
very much enlarged. The operation was com- 
menced in the entire extent of the linea alba 
below the umbilicus (medium incision), but this 
being found too small for exposing and dealing 
with the strong and extensive adhesions found 
to exist upon both sides of the incision, it was 
extended to the ensiform cartilage, making the 
whole length fourteen inches. This brought to 
view the same character of adhesions above the 
umbilicus as below it. After proceeding for a 
short distance in the breaking up of the adhe- 
sions on either side of the incision, with the 
fingers and handle of the scalpel, the tumor was 
opened at the prominent point indicated (to the 
left of the umbilicus) and about three gallons 
of gelatinous fluid removed. With this the 
breaking up of adhesions was continued on both 
sides to the entire extent of the abdominal 
mass, there being several points behind to 
which the small intestines were found to adhere, 
requiring careful dissections for their separation. 
This being completed, the large abdominal mass 
was lifted up and supported while the pelvic 
part of it, thus disengaged now in its entire 
extent, was dislodged from Douglass's pouch. 
The pedicle was next secured with a double 



■ 



MCDOWELL'S OTERARLON. 2 $l 

silver ligature, cut off close to the knots, and the 
tumor then cut away. After freeing the abdo- 
men of all fluids (there being but little hemor- 
rhage), the wound was closed in the usual way. 
The tumor, with the three gallons of fluid re- 
moved in the operation, weighed forty-five 
pounds, the weight of the patient being about 
ninety. The patient made a slow but complete 
recovery. 

This was my understanding of the superior 
advantages of the long incision of McDowell 
over the short and medium incisions. As to 
the result, the case speaks for itself. There is 
no surgeon, I venture to say, having a correct 
knowledge and appreciation of the principle of 
the long incision as here employed, who can 
claim that such a tumor, two-thirds solid, and 
complicated with such adhesions, could have 
been removed successfully by either the short 
or medium incision. Such is the class of cases 
in which a wider range is claimed for this long 
incision than is possible for any other, or com- 
bination of incisions. 

In my somewhat large experience since, in 
the employment of abdominal sections for the 
removal of both fibrous and ovarian tumors, in 
a large proportion of the cases (amounting to 



252 MCDOWELL'S OPERATLON. 

one-third, at least) I have found the same neces- 
sity for the long incision of McDowell as above 
described ; even in a second case 1 I may men- 
tion, the necessity arose in the extirpation of a 
large cyst of the pancreas — hitherto and up to 
the present time, so far as I am aware, the only 
case on record of a successful removal. 

It is these observations and the results I have 
obtained from the employment of the long in- 
cision of McDowell, that form my excuse for 
the presentation of the subject in these pages 
and the statement of my conviction of the obli- 
gations of the profession to McDowell for hav- 
ing given to the world a perfected operation, 
as far-reaching in its grand results to-day as 
when he first performed it. 

Having now carefully examined McDowell's 
operation of ovariotomy by his long incision, 
made in both the lower and upper divisions of 
the abdomen ; shown its relation to the old 
method of incisionism, restricted alone to the 
lower division of the abdomen, and practised 
without the slightest knowledge of the possi- 
bility of removing the dropsical ovary itself; 
contrasted its principles with those of the short 

1 N. Y. Med. Record, Jan. 14, 1882, p. 46. Ibid., by Dr. H. J. 
Garrigues, p. 286 ; also Diagnosis of Ovarian Cysts, Garrigues, 
1882, p. 86. 



MCDOWELL'S OPERATION. 253 

incision ; pointed out its languishing existence 
and slender hold upon the confidence of the 
profession for so many years ; its final revival 
in England and the United States ; and cited 
two typical cases illustrating its absolute and 
superior advantages over all other incisions of 
whatsoever character or combination, it remains 
to explain how the operation has been studied 
and its principles brought out in this and the 
several countries of Europe previously named. 

Commencing with the immediate followers 
of McDowell in the United States, the details 
of whose cases will appear in regular order, only 
one of them (Dr. Nathan Smith) employed the 
short incision, and one (Dr. Alban G. Smith) 
employed the medium incision ; the others 
(including Drs. Mussey, Rogers, Warren and 
Bellinger) employed the long incision, and the 
operations were completed in all except in the 
case of Dr. Mussey, and in two of Dr. Nathan 
Smith's, in which they were unable to remove 
the tumors. 

In France there is no case on record, so far 
as I have been able to discover, in which the 
operation of McDowell was employed during 
the period of its history under consideration. 
There is much of importance, however, con- 



2^4 MCDOWELL'S OPERATLON. 

nected with the old method of incisionism, em- 
ployed for the cure of dropsical ovaries, and in 
the general relation of this procedure to Mc- 
Dowell's operation by the long incision. These 
are interesting points which I have brought 
out, as will appear when we come to consider 
them. 

To Germany we are to look for the first 
recognition and employment of McDowell's 
procedure — a fact which has not hitherto, as 
far as I am aware, been brought to the notice 
of the profession, as shown by the various pub- 
lications I have examined. Upon this point I 
am able to speak with much confidence, since 
the details of the operations performed are given 
with so much precision by the surgeon (Dr. 
Chrysmar) in the reports of his three cases, 
though the name of McDowell is not mentioned 
in a single instance in connection with these 
operations. The histories of them have come 
down to us through the reports of Dr. Hopfer, 
of Biberbach, to whom these operations have 
been erroneously credited in various statistical 
tables ; but the facts show that he makes no pre- 
tensions to a claim of any operation that he ever 
performed, but only to have witnessed some of 
the operations of Dr. Chrysmar, and to have 



MCDOWELL'S OPERATION. 255 

sent one of the three cases to him specially for 
operation. 

Dr. Chrysmar's home at the time of his opera- 
tions, was in Isny, in the Kingdom of Wurtem- 
berg, and he is reported by Dr. Hopfer as 
enjoying at that period a wide reputation, ex- 
tending into the adjacent countries of Austria 
and Bavaria. His first operation was performed 
on May 16, 1S19, just two years after the ap- 
pearance of Dr. McDowell's first three cases 
in the Philadelphia Eclectic Reportory, and four 
months before he sent his second paper (Sep- 
tember, 1 8 19) to Dr. James, in Philadelphia, for 
publication in the same periodical. Dr. Chrys- 
mar's second operation was performed in 1820, 
and his third in April, 1827. His first two 
operations are probably the ones referred to by 
Mr. John Lizars, of Edinburgh, in his introduc- 
tion to McDowell's first three cases, published 
by the former in the Edinburgh Medical and 
Surgical Journal for October, 1824. Here he 
says that extirpation of the ovary had previ- 
ously been performed in France and Germany, 
leaving the reader to infer that the operation 
was performed in these countries prior to the 
date of McDowell's first operation in 1809, he 
then having had the report of McDowell's 



256 MCDOWELL'S OPERATLON. 

first three cases in his possession for seven 
years. 

All of the other operations performed in Ger- 
many after this are more or less distinctive of 
McDowell's procedure, especially as regards 
his long incision. Dr. Dolhoff, of Magdeburg, 
Prussia, reports a false diagnosis in his third 
case. From the history given of the case there 
is no doubt in my mind that the mistake in diag- 
nosis (consequently the unjustifiable operation 
that was performed) resulted from the existence 
of chronic cystitis, and probably of pyelitis 
brought about by repeated attacks of hysteri- 
cal retention of urine. The special groups of 
symptoms usually attendant upon these affec- 
tions are set forth more or less in detail in the 
history given. 

In Great Britain our attention is naturally 
directed first to the important operation of Dr. 
Robert Houston, by the old method of incision- 
ism — the first case, as far as we can determine 
from our investigation of the subject, as has 
been previously stated. Mrs. Margaret Millar, 
who resided near Glasgow, Scotland, aged fifty- 
eight, was the subject of this treatment, and 
Dr. Houston's operation was performed August, 
1 701, as found published in the London Philo- 



MC D O WEL L'S OPE J? A TION. 



257 



sophical Transactions, in 1724, twelve years 
before the date of Le Dran's first operation 
by the same procedure in France (1736). 

In this connection we note the published views 
of Dr. William Hunter, entitled Medical Ob- 
servations and Inquiries, London, 1762, which 
will appear in their proper place, as previously 
indicated ; as well as certain statements of Prof. 
James Blundell, in his " Researches, Physiologi- 
cal and Pathological," tending to prove the safety 
of the operation of extirpation of the ovary, and 
the justifiability in surgeons performing it. 

The explanation of the extraordinary course 
pursued by Mr. John Lizars toward Dr. Mc- 
Dowell in withholding his cases from publica- 
tion for seven years, as given in connection 
with the report of his own first case, operated 
upon by the long incision of McDowell (Octo- 
ber 24, 1823), will be learned from extracts 
presented, while comments will be given upon 
the details of this and his other three cases, 
in all of which McDowell's procedure was 
employed. 

In this connection also will appear the unjust 
criticisms of Dr. James Johnson, the learned 
editor of the Medico- Chirurgical Review ^ upon 
the operation of McDowell, together with his 



17 



258 MCDOWELL'S OPERATLOX 

retractions of the same after discovering- his 
error. 

The several other operations performed in 
Great Britain after those of Mr. Lizars may be 
said to be principally the short incision opera- 
tions of William Jeaffreson, Esq., of Framling- 
ham, England, and his imitators, as already 
referred to, of which cases abstracts, more or 
less in detail, will be found in the regular order 
of presentation. 

Having concluded our g-eneral survev of the 
subject before us, we are now better prepared 
to appreciate the historical facts to be brought 
out more in detail and commented upon. 

The plan, as foreshadowed, will be to divide 
the subject into four sections,' corresponding to 
the countries referred to, commencing- with the 
United States. Naturally this brings us first to 
the presentation of McDowell's eight cases, 
five of which are copied in full, with abstracts 
of criticisms upon his operation and quotations 
from the same, together with answers and com- 
merits thereupon by himself. Of the remaining 
three cases the facts presented are based upon 
the highest authoritv. 



IX THE UXITED STATES. 2 $Q 



SECTION I. 

UNITED STATES. 

~Three Cases of Extirpation of Diseased Ovaria, 1 
By Ephraim McDowell, M.D., of Danville, Kentucky. 

In December, 1899, I was called to see a Mrs. Crawford, 
who had for several months thought herself pregnant. She 
was affected with pains similar to labor pains, from which 
she could find no relief^ So strong was the presumption 
of her being in the last stage of pregnancy that two phy- 
sicians, who were consulted on her case, requested my aid 
in delivering her. The abdomen was considerably enlarged 
and had the appearance of pregnancy, though the inclina- ■' 
tion of the tumor was to one side, admitting of an easy 
removal to the other. Upon examination, per vaginam, 
I found nothing in the uterus, which induced the conclu- 
sion that it must be an enlarged ovarium. Having never 
seen so large a substance extracted, npr heard of an attempt 
or success attending any operation such as this required, I 
gave to the unhappy woman information of her dangerous 
situation. She appeared willing to undergo an experiment, 
which I promised to perform if she would come to Dan- 
ville (the town where I live), a distance of sixty miles from 
her place of residence. This appeared almost impracticable 
by any, even the most favorable conveyance, though she 
performed the journey in a few days on horseback. With 
the assistance of my nephew and colleague, James Mc- 
Dowell, M.D., I commenced the operation, which was 
concluded as follows : Having placed her on a table of the 
ordinary height, on her back, and removed all her dressing 
which might in any way impede the operation, I made an 

x The Eclectic Repertory, 1817, vol. vii., p. 242. 



2 6o MCDOWELL'S OPERATLON 

incision about three inches from the museums rectus ab- 
dominis, on the left side, continuing the same nine inches 
in length, parallel with the fibres of the above-named mus- 
cle, extending into the cavity of the abdomen, the parietes 
of which were a good deal contused, which we ascribed to 
the resting of the tumor on the horn of the saddle during 
her journey. The tumor then appeared full in view, but 
was so large that we could not take it away entire. We 
put a strong ligature around the Fallopian tube near the 
uterus, and then cut open the tumor, which was the ovarium 
and fimbrious part of the Fallopian tube very much en- 
larged. We took out fifteen pounds of a dirty, gelatinous- 
looking substance, after which we cut through the Fallopian 
tube and extracted the sack, which weighed seven pounds 
and one-half. As soon as the external opening was made 
the intestines rushed out upon the table, and so completely 
was the abdomen filled by the tumor that they could not 
be replaced during the operation, which was terminated 
in about twenty-five minutes. We then turned her upon 
her left side, so as to permit the blood to escape, after 
which we closed the external opening with the interrupted 
suture, leaving out, at the lower end of the incision, the 
ligature which surrounded the Fallopian tube. Between 
every two stitches we put a strip of adhesive plaster, which, 
by keeping the parts in contact, hastened the healing of 
the incision. We then applied the usual dressings, put her 
to bed, and prescribed a strict observance of the anti- 
phlogistic regimen. In five days I visited her, and much 
to my astonishment found her engaged in making up her 
bed. I gave her particular caution for the future, and in 
twenty-five days she returned home as she came, in good 
health, which she continues to enjoy. 

Since the above case I was called to a negro woman, 
who had a hard and very painful tumor in the abdomen 
(1813). I gave her mercury for three or four months with 
some abatement of pain, but she was still unable to perform 
her usual duties. As the tumor was fixed and immovable, 



TV THE UNITED STATES. 



26l 



I did not advise an operation ; though, from the earnest 
solicitation of her master, and her own distressful condition, 
I agreed to the experiment. I had her placed upon a 
table, laid her side open as in the above case, put my hand 
in, found the ovarium very much enlarged, painful to the 
touch, and firmly adhering to the vesica urinaria and fundus 
uteri. To extract I thought would be instantly fatal ; but, 
by way of experiment, I plunged the scalpel into the dis- 
eased part. Such gelatinous substance as in the above 
case, with a profusion of blood, rushed to the external 
opening, and I conveyed it off by placing my hand under 
the tumor and suffering the discharge to take place over it. 
Notwithstanding my great care, a quart or more of blood 
escaped into the abdomen. After the hemorrhage ceased 
I took out as cleanly as possible the blood in which the 
bowels were completely enveloped. Though I considered 
the case as nearly hopeless, I advised the same dressings 
and the same regimen as in the above case. She has en- 
tirely recovered from all pain and pursues her ordinary 
occupation. 

In May, 181 6, a negro woman was brought to me from a 
distance. I found the ovarium much enlarged, and as it 
could be easily moved from side to side, I advised the ex- 
traction of it. As it adhered to the left side I changed my 
plan of opening to the linea alba. I began the incision, 
in company with my partner and colleague, Dr. William 
Coffer, an inch below the umbilicus, and extended it to 
within an inch of the os pubis. I then put a ligature 
around the Fallopian tube and endeavored to turn out the 
tumor, but could not. I then cut to the right of the um- 
bilicus, and above it two inches, turned out a scirrhous 
ovarium (weighing six pounds), and cut it off close to the 
ligature put around the Fallopian tube. I then closed the 
external opening, as in the former cases, and she com- 
plaining of cold and chilliness, I put her to bed prior to 
dressing her; then gave her a wineglassful of cherry bounce 
and thirty drops of laudanum, which soon restoring her 



2 62 MCDOWELL'S OPERATION 

'warmth, she was dressed as usual. She was well in two 
weeks, though the ligature could not be released for five 
weeks, at the end of which time the cord was taken away, 
and she now, without complaint, officiates in the laborious 
occupation of cook to a large family. 

As to the estimate of the reports of the above 
cases of Dr. McDowell, and the value attached 
to the results of his three operations soon after 
their publication, I deem it of interest to men- 
tion the opinions of two physicians, as found 
expressed in the Eclectic Repertory (1818) : one, 
as a critic of the operations of Dr. McDowell, 
Dr. Ezra Michener, of Philadelphia ; and the 
other, Dr. Thomas Henderson, of Georgetown, 
D. C, as a defender of them. 

Dr. Michener, under the title of a " Case of 
a Diseased Ovarium," 1 said the diagnosis was 
not clear. He thought, however, the case was 
one of " ovarium disease, but whether scirrhous 
or hydropic, could not so satisfactorily deter- 
mine." Dr. James was called in consultation, 
and fully corroborated his opinion. The patient, 
Rosanna Albert, after two prescriptions of diu- 
retics for the accompanying dropsical effusion, 
absolutely refused to take the medicines pre- 
scribed, and soon after died. At the autopsy, 
in addition to an enlarged and scirrhous state 

o 

1 Op. cit., 1 8 18, vol. viii., p. 242. 



IN THE UNITED STATES. 2 6$ 

of the pancreas, there were " found the uterus 
and tumor so intimately united as to render it 
impossible to distinguish or separate them" ; the 
latter, when removed, weighing eight pounds 
and ten ounces. The fault Dr. Michener found 
with Dr. McDowell was that he told what 
dropsy of the ovary was in his first case, but 
did not make himself intelligible regarding 
11 diseased ovaria " of a " scirrhous or hydropic" 
character. He adds : 

" It is a wish to give you a countepart for Dr. McDow- 
ell's paper that induces me to offer this account for your 
disposal. 

"While his hand holds forth the successful blade as an 
ensign for the bold and dexterous surgeon, may I humbly 
point to the dangers which lurk under the obscure and de- 
lusive indications of this species of disease ? 

"It is much to be regretted that cases so interesting to 
the community as those of Dr. McDowell, and as novel as 
interesting, should come before the public in such a man- 
ner as to frustrate the intention of becoming useful. 

"Far be it from me to arraign the probity of Dr. Mc- 
Dowell. If the cases he relates are — as I sincerely hope 
them to be — correctly stated, no remarks of mine can 
detract from his merit." 

And, after criticising Dr. McDowell's opera- 
tions, and his descriptions of them, he concludes 
as follows : 

" The utter impossibility of our ever being able to ascer- 
tain with certainty the real nature of those internal diseases, 
the delusive nature of all their indications, and the neces- 



264 



MCDOWELL'S OPERATION 



sary danger of an operation under the most favorable cir- 
cumstances, will be likely to prove an insurmountable 
barrier to the use of the knife in their removal, as few per- 
sons will be likely to venture their reputation on such 
uncertain data." 

Dr. Henderson, in a paper entitled " On 
Ovarian Disease and Abdominal Steatoma," 1 
read before the Medical Society of the District 
of Columbia, July, 181 8, takes just the opposite 
view to that of Dr. Michener of Dr. McDowell's 
three reported cases. He refers to these cases 
and the operations performed by McDowell, in 
a pleasing and dignified manner, in connection 
with the unsuccessful treatment of his own case 
of steatoma, and the result of the autopsy that 
followed. His patient, aged eighteen, was a 
negress, who came under his observation in 
October, 18 16, the case then " evidently tending 
to a fatal termination." Dr. Cook, in a consul- 
tation, corroborated Dr. Henderson's opinion — 
to wit, that the tumor occupied a somewhat 
central position in the abdomen, was neither 
connected with the uterus nor the bladder, and 
that it ought to be tapped. This operation was 
performed, but no fluid was found, and death 
followed three weeks after. At the autopsy it 
was found that — 

1 Op. cit., 1818, vol. viii., p. 545. 



IN THE UNITED STATES. 



265 



"The tumor adhered closely on each side of the edges 
of the abdominal (recti) muscles, through which it seemed 
to have protruded, separating and throwing them to each 
side, and the investing membrane adhered below to the os 

pubis The tumor was a steatoma ; the suety 

matter was contained in cysts of different dimensions, from 
the size of a grape to that of a hen's egg. The color of 
the steatoma was various, as the size of the cysts in which 
it was contained ; being in some parts of the tumor of the 
color of coagulated blood, and again white, with all the 
intermediate shades. ' ' 

The tumor held no relations whatever with 
either ovary, and weighed about nine pounds. 

"The right ovarium, however, was as large as the gall- 
bladder of an adult, containing thin purulent matter, and 
almost full of black hair ; a part of the hair growing from 
the internal surface of the organ, the rest loosely lying in 
the purulent matter. The Fallopian tubes in a natural 
state." 

Dr. Henderson, after completing his remarks 
upon the peculiarities and the result of his case 
(the immediate cause of death being, no doubt, 
septicaemia following suppuration and rupture 
of the small dermoid cyst revealed by the 
autopsy), proceeds to comment upon Dr. Mc- 
Dowell's three cases in the following manner: 

"While I unite with Dr. Michener in expressing my 
deep regret that a more particular detail has not been pre- 
sented of these remarkable cases, yet, in one point of view, 
they are completely satisfactory in proving that an opera- 
tion may be successful in cases which have, I fear, too fre- 



2 66 MCDOWELL'S OPE RATI OX 

quently been allowed to proceed undisturbed to a fatal 
termination. . . . Let the surgeon reflect on the pro- 
gress that has been made within the last century in dis- 
tinguishing the seats and characters of internal diseases ; 
let him contemplate, too, the astonishing powers which the 
constitution manifests in restoration from injuries ; let him 
exercise the same decision in the use of the knife which 
Dr. McDowell displayed, and that research in all fatal 
cases which Dr. Michener manifested in inquiring into the 
cause and seat of diseases; and the latter gentleman will 
probably live to see the time when he will with pleasure 
acknowledge the inapplicability of the views held out in 
the last paragraph (of his paper) to the power of the sur- 
geon's discernment and the effect of his knife." 

I next present the history of two additional 
cases of ovariotomy by Dr. McDowell, which, 
with the three previously given, constitute the 
only five cases published in detail. This report 
is communicated to Dr. James, of Philadelphia, 
in the form of a letter, with answers to certain 
criticisms of Dr. Michener as set forth in the 
remarks of Dr. Henderson upon his cases, Dr. 
[McDowell not having previously seen these 
criticisms. In the fact that Dr. Michener had 
made such criticisms is no doubt to be found 
the explanation why Dr. McDowell sent this 
paper directly to Dr. James, who had seen Dr. 
Michener's case in consultation, and was then 
a leading practitioner and teacher in Philadel- 
phia. 



TV the united states. 



267 



"Observations on Diseased Ovaria} 



" By Ephraim McDowell, M.D. 

September, 1819. 

" Dear Sir : I am induced to make this statement, 
principally in consequence of the observations of Dr. Hen- 
derson, which appeared in a number of the Repertory, 
published twelve or fifteen months since, ' On Ovarian 
Disease and Abdominal Steatoma. ' 

" Since my former communication I have twice per- 
formed the operation of excision, which cases are sub- 
joined." 

There are three points criticized by Dr. Mich- 
ener : First, with reeard to the length of the 
incision made by McDowell in his first case. 
To this Dr. McDowell replies : 

" As I did not actually measure the incision, it would, 
perhaps, have been better to have said, an incision was 
made, about three inches to the left of the musculus rectus, 
extending from the margin of the ribs to the os pubis, on 
a woman whose abdomen was distended by a tumor to an 
enormous size." 

Second, regarding the contused injury on the 
left side of the abdomen, attributed to the horn 
of the side-saddle, and mentioned by Dr. Mich- 
ener as being within the field of operation, to 
which Dr. McDowell replies : 

" Now, with all due deference to the Doctor's knowledge 
in surgery, and the structure of side saddles, I think it 
would not be difficult to conceive that a tumor weighing 

1 Op. cit., 1 8 19, vol. ix., p. 546. 



2 68 MCDOWELL'S OPERATLON 

upward of twenty pounds would fill the whole abdomen, 
and, although attached to the left ovarium, the weight and 
bulk must have been almost, if not quite, as great on the 
right side as on the left. I would observe that my patient 
was a woman of small stature ; her abdomen had become 
so pendulous as to reach almost to her knees; the size of 
the tumor was ascertained from actual weight. Had the 
left side of the abdomen been contused, I would either 
have delayed the operation until the contusion was re- 
moved or operated on some other part. I never have been 
of opinion that bruised flesh would heal so readily as sound, 
which matter I esteem of essential importance to success 
in this operation." 

Third, as to the patient's getting up on the 
fifth day and making her bed, to which Dr. 
McDowell answered : 

" The Doctor's scepticism alone appears to have carried 
him through the statement, and I am surprised that he will 
even admit the fact of her returning home, on horseback, 
in five and twenty days after the operation, a distance of 
seventy miles, and in the depth of winter." 

Dr. McDowell answers, in a general way, 
other criticisms, both of Drs. Michener and 
Henderson, by reference to the qualifications 
of a surgeon, and his fitness for the important 
work usually expected of him. He displays in 
these remarks the keenest sense of honor and 
the highest appreciation of his own responsi- 
bility in giving to the profession the results of 
his experience in connection with the operations 
in question. He says : 



IN THE UXITED STATES. 



269 



" Dr. Henderson thinks I was entirely too inconsiderate 
in my detail of the cases of diseased ovaria ; I thought my 
statement sufficiently explicit to warrant any surgeon's per- 
forming the operation when necessary, without hazarding 
the odium of making an experiment ; and I think my de- 
scription of the mode of operating, and of the anatomy of 
the parts concerned, clear enough to enable any good 
anatomist possessing the judgment requisite for a surgeon 
to operate with safety. I hope no operator of any other 
description may ever attempt it. It is my most ardent wish 
that this operation may remain, to the mechanical surgeon, 
forever incomprehensible. Such have been the bane of the 
science ; intruding themselves into the ranks of the profes- 
sion, with no other qualification but boldness in undertak- 
ing, ignorance of their responsibility, and indifference to 
the lives of their patients ; proceeding according to the 
special dictates of some author, as mechanical as themselves, 
they cut and tear with fearless indifference, utterly incapa- 
ble of exercising any judgment of their own in cases of 
emergency, and sometimes without possessing even the 
slightest knowledge of the anatomy of the parts concerned. 

"The preposterous and impious attempts of such pre- 
tenders can seldom fail to prove destructive to the patient 
and disgraceful to the science. It is by such this noble 
science has been degraded, in the minds of many, to the 
rank of an art." 

" Case I. (IV.) — In April, 181 7, I operated on a negro 
woman from Garard County, extracting a scirrhous ova- 
rium weighing five pounds. The incision was made near 
the linea alba. As in the cases formerly related, I tied a 
cord firmly round the ligament, attaching it to the uterus, 
and cut away the ovarium ; but, owing to the shortness and 
sponginess of the part, the cord slipped off before I laid 
the ovarium out of my hands, and a profuse discharge of 
blood took place. I immediately drew the uterus to the 
external incision and commenced tying up the bleeding 



270 



MC D WE LL'S OPERA TION 



mouths separately. This aho, in consequence of the dis- 
eased state of the parts, proved only of partial efficacy, as 
several of the ligatures cut through on tying them. I now 
thought it all over with my poor patient ; but, arming a 
needle with a strong ligature, I passed it round the liga- 
ment, securing it in its place by taking several stitches over 
its surface as I passed it round, and firmly tied it. By 
turning her nearly on her stomach, I was able to get most 
of the blood out of the abdomen, using my hand to extract 
the coagulated portion. The incision was then closed by 
the interrupted suture and strips of adhesive plaster. She 
recovered happily, but I am told her health is not good ; 
the account I had of her was awkwardly given ; from what 
I could learn her complaint is hysterical. This, though 
the smallest ovarium I have ever extracted, was much more 
troublesome to the patient than in any previous case. Be- 
side experiencing severe lancinating pains in the parts, she 
was seldom able to discharge her urine without getting 
almost on her head, in consequence of the tumor falling 
down into the pelvis and compressing the urethra." 

" Case II (V). — A negro woman from Lincoln County 
was brought to me in April, 1818, supposed, by the differ- 
ent physicians who had attended her, to be affected with 
ascites ; she had been under their care about eighteen 
months. On examining her I could very plainly discover 
the fluctuation of fluid in the abdomen, and for some 
months administered medicine for ascites, without effect ; 
despairing of the power of medicines, I at length tapped 
her, and discharged thirteen quarts of gelatinous fluid, such 
as I had before met with in dropsical ovaria, of so thick a 
consistence that I found it extremely difficult and tedious 
to discharge it. In two months after I found it necessary 
to tap again ; during the process of discharging it a second 
time the opening was frequently stopped by viscid portions 
of the jelly, which were broken by introducing a probe ; 
when the abdomen was pretty well evacuated I discovered, 



IN THE UNITED STATES. 



271 



with the probe, a firm substance, which, on minute exami- 
nation, I found to be of considerable size. I at once sup- 
posed the existence of dropsical ovarium, in which I was 
confirmed on finding the uterus empty by examination /<?/- 
vaginam. Some months after she was again tapped, at 
which time I made the opening large enough to admit my 
finger, by which means I was able to ascertain the nature 
of the disease beyond a doubt. I informed her master 
what was certainly her situation, and that nothing but ex- 
cision could effect a cure. My advice was not immediately 
followed, nor until after she was tapped a fourth time, a 
week or two after which she was brought to Danville to 
undergo the operation, which was performed May 11, 1819. 
The diseased ovarium being on the left side and evidently 
dropsical, the incision was, of course, made on the left side. 
On exposing the tumor it was found to adhere to the 
parietes of the abdomen and to the intestines by slender 
cords, which were easily separated with the hand and 
which caused a slight effusion of blood. To the uterus two 
strong ligaments adhered ; one, the natural ligament, attach- 
ing the ovarium to the uterus ; the other, an artificial one, 
attached to the fundus uteri ; which appeared to be com- 
posed of the above-mentioned slender cords compacted 
together. I then tied fine cords of silk firmly round each 
of these ligaments, discharged the contents of the tumor, 
and cut it away. 

" There were sixteen quarts of gelatinous fluid discharged 
from the tumor and abdomen. The dressings and precau- 
tions were the same as in other cases. The second day 
after the operation she was affected with violent pain in the 
abdomen, together with an obstinate vomiting. She was 
blooded as copiously as her strength would allow, but 
without producing any abatement of the pain or vomiting. 
On the third day she died. On examination after death 
the uterus, contrary to expectation, appeared natural and 
uninflamed, the right ovarium healthy, the silken cords 
were securely and properly fixed, and not in a situation 



272 MCDOWELL'S OPERATION 

likely to injure the adjoining parts. Her death had pro- 
ceeded from peritoneal inflammation. This membrane, 
throughout its whole extent, appeared greatly inflamed, 
and the intestines largely inflated. 

"I was assisted in this operation by my nephew, Dr. 
William A. McDowell ; Drs. Weizegar, Tomlinson, and 
Horr were present. 

"On examining the substances we had removed, the 
contents of the sac presented a variety ; different portions 
of the fluid were of different colors — semi-transparent, 
white, brown, and yellow. There was also contained in 
the sac a considerable quantity of hair, which grew from 
the inner surface. Enveloped in the inner substances of 
the sac we found a bone, resembling very much in shape 
the front tooth of a cow. 

"From the circumstances of the hair and bone one or 
two of the physicians present were inclined to believe the 
disease originated from an extra-uterine conception, and 
that all of the foetus had been absorbed, save the hair and 
single bone, which was found. This question I submit to 
the faculty. As for myself, I think it is as reasonable to 
suppose the hair and bone in this unnatural situation was 
the result of a morbid action. She had been delivered of 
a child two years before the operation ; her health during 
that time was never good, but she had no reason to believe 
herself pregnant; and if it were the case, I doubt whether 
a whole foetus could be so nearly absorbed in two years. 
There was likewise a round hole in the sac which, from the 
level appearance of its edges, appeared of long standing ; 
the hole was about the size of a musket ball, and there is 
no doubt that the gelatinous fluid escaped through this 
aperture into the abdomen. This ovarium, when brought 
into view, was of a large size, which is the more remark- 
able when we consider the enormous quantity of fluid which 
had been drawn off at different times by the operation of 
paracentesis abdominis. During the evacuation a bandage 
was kept bound tightly around the abdomen, and consid- 



IN THE UNITED STATES. 



273 



erable pressure was made with the hands, in order to evacu- 
ate its whole contents. In an attempt to draw off the 
contents of such a tumor with a trocar it would be impos- 
sible to perforate all the vesicles, 1 and such only as were 
pierced would discharge their contents. While one por- 
tion of the vesicles of the ovaria would discharge themselves 
into the abdomen another portion would remain diseased 
in the original way, thus compounding in the system two 
of the most deplorable diseases to which it is liable. 

" Ephraim McDowell. 
" Dr. James." 

Comments : Recognizing the two divisions of 
the abdomen (the lower and upper), formed by 
a line running across the axis of the body at the 
umbilicus, the reader will be better prepared 
to appreciate the distinctive features of the 
author's procedure in his first case, based upon 
his long incision ; his exposure to the fullest 
extent possible of the peritoneal cavity ; and 
his successful extirpation of the diseased ovary 
found to exist. This incision was made in both 
the lower and upper divisions of the abdomen, 
external to and parallel with the left rectus 
muscle, being in contravention to the old 
method of incisionism restricted simply to the 
lower division of the abdomen. Through the 

1 " That this is the structure of diseased ovaria, I infer, both 
from authorities, and from the difficulty in discharging their 
contents. I have always been under the necessity of intro- 
ducing my hand and raking it forth, the obstacle to the dis- 
charge being always a membranous structure." 
18 



274 MCDOWELL'S OPERATION 

opening thus made, he applied a ligature around 
the pedicle of the tumor, laid the latter open, 
cut it away, and then, bringing the two ends of 
the ligature out at the lower angle of the wound, 
closed this up with sutures and adhesive strips, 
completing the dressing with compress and 
roller. This was the first deparhtre that had 
ever been made from the old procedure of inci- 
sionism based upon the principle of simply 
opening the peritoneal cavity and the tumor 
jointly, and then, after evacuating the contents 
of the cyst, inducing inflammation, suppuration 
and obliteration of its cavity through drainage 
and injections. 

The author in his five cases established seve- 
ral other distinctive and important principles of 
practice. In addition to the safety, and conse- 
quently the value, of his long incision extended 
from the lower to the upper division of the 
abdomen, and the complete exposure of the 
peritoneal cavity, combined with the practica- 
bility of a completed method of operating for 
the extirpation of a diseased ovary of what- 
soever character, the several principles above 
alluded to may be set forth in a general way : 
The introduction of one or both hands for the 
manipulation of the tumor and the searching 



IN THE UNITED STATES. 2 y$ 

for and breaking up of adhesions when present ; 
the modified restriction of his long incision to 
the medium or short in the lower division of the 
abdomen, admitting one hand or one finger for 
whatsoever purposes, described in his third and 
fifth cases ; the principle of making a long 
incision admitting one or both hands for com- 
pleting the diagnosis as to the character of a 
fibrous growth of the uterus, as in the second 
case; the practicability, after discovering, as 
in the same case, that the tumor could not be 
safely removed, of puncturing and emptying 
the principal cyst in it, from which a cure 
resulted; the turning of the patient upon the 
left side, and even upon the stomach, as in the 
first and fourth cases, to facilitate the emptying 
of the fluids out of the cyst and the peritoneal 
cavity, in order to avoid rough handling of the 
peritoneum; the principle of putting the liga- 
ture around the pedicle before puncturing or 
removing the tumor from the abdomen- — a line 
of practice doubtless resulting from fear of 
hemorrhage by opening the cyst first; the 
principle of bringing the two ends of the liga- 
ture out in the lower angle of the wound at the 
time of closure, to facilitate its speedy escape 
from the peritoneal cavity as a foreign sub- 



276 



MC D O WELL'S OPERA TLOX 



stance, either spontaneously or by traction 
upon it from time to time. In the fourth case 
(unquestionably a fibrous growth of the uterus) 
the author witnessed, for the first time, the acci- 
dent of the ligature slipping off the pedicle 
because of its shortness, and the danger result- 
ing therefrom, which he successfully overcame 
by an impromptu procedure, combined, it is 
inferred, with cutting- off the ends of the lira- 
tures close to the knots. In the fifth case, after 
a third tapping, he established the precedent of 
a short exploratory incision, admitting one fin- 
ger, to complete his diagnosis. In the same 
case he established a second precedent, after 
removal of a dermoid cyst, by employing the 
intra-peritoneal treatment of the pedicle ; and 
although the patient died on the third day, he 
found at the autopsy his " fine cords of silk" 
" properly fixed and not in a situation likely to 
injure the adjoining parts" — a description 
clearly showing that the ligature had been cut 
off with the pedicle, and left to its chances of 
absorption. The closure of the wound of the 
abdomen, as in the first case, with interrupted 
sutures, together with broad adhesive strips, 
compress and roller, and the " observance of 
the antiphlogistic regimen," all indicate impor- 






IN THE UNITED STATES. 



277 



tant principles of practice pursued in these 
cases. 

This concludes Dr. McDowell's five cases, 
believed, as previously stated, to be the only 
ones published by him in detail ; but there is no 
doubt that he operated upon other cases, and 
this claim rests on the indisputable authority of 
the late Prof. S. D. Gross. In the "Report on 
Kentucky Surgery," which he presented to the 
Kentucky State Medical Society, October, 1852, 
Dr. Gross states that the whole number of 
cases operated upon by Dr. McDowell is not 
positively known, but from what he has been 
able to learn directly from his nephew, Dr. Wm. 
A. McDowell (formerly of Louisville), he per- 
formed the operation, from first to last, thirteen 
times. Dr. Gross, however, credits him with 
only three additional cases besides the five 
above presented, making in all eight (four 
white and four negro women). These last 
three cases (all in white women), the particu- 
lars of which Dr. Gross learned from direct 
and trustworthy sources, all belong to the period 
of the first seven years, extending from 18 19 
to 1826, inclusive, which followed the date of 
Dr. McDowell's last publication. Their histo- 
ries are herewith given in chronological order. 



2 ; 8 MCDOWELL'S OPERATLON 

Case VI. — Mrs. O., of Nashville, Tennessee, aged fifty- 
five, and inclined to corpulency. She first noticed (De- 
cember, 1 821) on the left side and a little below the 
umbilicus, a small globular tumor, movable from side to 
side, as well as from above downward, destitute of sensi- 
bility, and, up to this stage of the growth, attended with 
but little inconvenience. The following summer, however 
(1822), there was considerable augmentation in the volume 
of the growth, with corresponding increase of discomfort, 
and Dr. McDowell was requested to visit the patient at her 
home by her family physician, Dr. James Overton. 

Dr. McDowell, after a careful examination of the case, 
decided upon an operation for the removal of the tumor. 
He cautiously made his medium incision in the linea alba 
below the umbilicus and over the most prominent part of 
the growth, intending to extend this into his long incision 
above the umbilicus in order to facilitate the different 
steps of the operation. In this, however, he was disap- 
pointed, "for he had no sooner made his first incision 
through the peritoneum than there gushed out, in a full 
stream, a bloody-looking serum, which continued to flow 
till the sac which had contained it was apparently entirely 
empty. The quantity thus lost was about one gallon." 
Judging that the character of the tumor and its surround- 
ings were unfavorable for removal, he made no further 
attempt to complete the operation, but closed the incision, 
leaving a tent in its lower extremity to insure drainage. 
■ "The patient, who lived from fifteen to twenty years after 
the operation, enjoyed excellent health." The details of 
the after-treatment of the operation were furnished Dr. 
Gross by Dr. Overton. 

As an interesting incident connected with the 
operation in this case, and referred to by Dr. 
Gross, may be noted the presence of General 
Andrew Jackson, before he was President, "a 



jy THE UXITED STA TES. 



279 



neighbor of the patient, who assisted in holding 
her hands and supporting her resolution." 

Case VII. — Miss Plasters, May, 1823. The circum- 
stances attending this case were furnished Dr. Gross by 
Dr. W. C. Gait, of Louisville, Kentucky, and were con- 
tained in a letter received by the latter from Dr. McDowell. 
An abstract of the case from Dr. Gross's report is here pre- 
sented. When the patient reached Danville to consult Dr. 
McDowell the tumor was found to fill the entire abdominal 
cavity, although it had been tapped only three months 
previously. She was so extremely debilitated that he be- 
lieved she would hardly be able to sustain the shock of the 
operation. After a few days rest, however, he proceeded 
to make his usual long incision, extending the whole length 
of the linea alba, and removed the tumor without difficulty. 
The pedicle was tied and the wound carefully closed in the 
usual manner. Recovery followed. The patient duly 
regained her usual good health and spirits and the follow- 
ing spring (April, 1824) "engaged herself to marry." 

Case VIII.— Mrs. Melano, of Chillicothe, Ohio (1826), 
aged thirty-eight. Her case will also be presented in ab- 
stract from Dr. Gross's report. She first noticed a fullness 
in the right side of her abdomen in the autumn of 1822. 
In December, 1825, it is stated "a. hard tumor was dis- 
covered in the right ilio-hypogastric region which has 
steadily increased in volume and now occupies the whole 
abdominal cavity, from the pubic symphysis to above the 
umbilicus, reaching outwardly as far as the costal cartilages. 
It is hard, irregular, slightly movable, and cannot be 
traced under the ribs." The above notes were made by 
the late Dr. Daniel Drake, of Cincinnati, October 24, 
1826, when the patient was on her way to Danville to con- 
sult Dr. McDowell. On her arrival there, and after a 
thorough examination of her case, Dr. McDowell thought 
it possible to remove the tumor, notwithstanding his belief 



2 8o MCDOWELLS OPERATION 

that extensive adhesions existed. He accordingly made 
his usual long incision through the linea alba, and exposed 
the tumor, which had firm adhesions with the omentum. 
After fully opening the peritoneal cavity he found the ad- 
hesions even more extensive than he had at first supposed. 
By the time he had gotten the omentum separated the 
patient became so exhausted that the operation had to be 
suspended, and finally it was abandoned altogether. The 
wound was immediately closed up, and in about two weeks 
it had entirely healed, the patient's general condition 
seeming to be very much the same as it was before the 
operation. Dr. Drake saw this woman the following March 
(1827) and " found her excessively emaciated, with swell- 
ing of her right leg, and all the symptoms of gradual ex- 
haustion." Death took place soon afterward. No autopsy 
was made. 

Out of the authors 8 operations reported by 
him (4 in white and 4 in negro women), 5 were 
completed, and 3 were unfinished, but recov- 
ered. Of the 5 completed operations there 
were 2 in white and 3 in negro women, with 1 
death among the latter. Mortality of completed 
operations, 20 per cent. 

Further Comments. — In the reports of these 
eight cases, four in white and four in negro 
women, the fact of the equal liability of the two 
races to ovarian tumors (which the author's ex- 
perience proved) is brought to light, probably 
for the first time. The general belief of the 
profession now, however, is that the liability to 
ovarian tumors is largely in favor of the white 



IN THE U XI TED STATES. 2 8l 

race, and vice versa, to fibroid tumors in favor 
of the black race. This experience of the author 
regarding the general character of the tumors 
in these cases (treated at a time when fibrous 
growths were generally regarded as scirrhous 
growths) may be explained or reconciled with 
our present views on the supposition of his 
erroneous diagnosis in some of the cases he 
operated upon, especially in those of negresses. 
One of these cases, the second of the series, 
was certainly an interstitial or a sessile fibrous 
growth of the uterus ; and there is but little 
doubt that the third and fourth cases were of 
the pedunculated variety of the same. As to 
the remaining one, the fifth case, the tumor 
was unquestionably a dermoid cyst, a diagnosis 
which accords fully with the author's history of 
the case and the graphic description of his 
operation, as well as with the general character 
of the specimen removed. Of the sixth case 
enough has been said to convince any one 
familiar with the subject that the tumor found 
was a fibroid growth of the uterus and that 
ascites had resulted from the irritation of the 
peritoneum caused by it. The patient remained 
well or comfortable for fifteen or twenty years 
after the operation, thus proving that the empty- 



282 MCDOWELL'S OPERATLOX 

ing and draining of the peritoneal cavity was 
more or less curative, contrary to the result 
that would have followed had the tumor been 
ovarian. The seventh case was unquestionably 
one of ovarian tumor, and presented nothing 
unusual in the result of the operation further 
than the proving of the safety and value of the 
long- incision. In the eighth case the tumor, if 
not a fibrocystic of the uterus, was probably a 
dermoid cyst, complicated, as was found, with 
extensive adhesions. This operation was per- 
formed only four years before the author's death 
(1826), and there is no evidence, as far as the 
study of the subject goes, to show that he ever 
undertook another operation after the date of 
this one. 

The significance of the facts brought out is 
that the tumors in the two successful cases in 
negresses (Cases III. and IV.), were peduncu- 
lated growths of the uterus, involving greater 
difficulties in the operations, which consequently 
augment in a corresponding degree the statisti- 
cal value of the author's success. In Case IV. 
the pedicle was so short that the ligature slipped 
off after it was tied, resulting in great loss of 
blood before another could be applied and 
secured. 



IN THE UNITED STATES. 283 

As regards a most embarrassing difficulty 
encountered in Case I., it may be remembered 
that the intestines protruded from the abdominal 
cavity, and remained out of the body twenty-five 
minutes, or until the pedicle could be tied and 
the tumor laid open and emptied. Again, as 
an incident in the after-treatment of this case, 
it will be recalled that the author at his visit on 
the fifth day found the patient up and making 
her bed. With such imprudence and disregard 
of ordinary judgment on her part it was, there- 
fore, only by mere accident or " good luck " that 
the immense importance of this first success was 
not lost to science and humanity. In the only 
case (V.) in which death resulted a dermoid 
cyst was found, with the usual complications in 
such cases from repeated tappings — viz., numer- 
ous and strong adhesions. At the time of the 
operation the patient had undergone four tap- 
pings, and her general condition of health was 
much depreciated. Extensive parietal and intes- 
tinal adhesions had to be broken up and several 
bleeding vessels had to be tied, so that peri- 
tonitis supervened, from which death resulted 
on the third day. Such a result was to be 
expected. 

Of the three unfinished operations but little 



284 



MCDOWELL'S OPERA TLON 



is to be said further than that the abdomen was 

opened and the removal of tumor found to be 

impossible. It is clear enough to the mind of 

the reader that the tumors in Cases II. and VI. 

were uterine ; and, as to Case VIII., it presented 

complications of the gravest character, as shown. 

Case IX. — Entitled: "Case of Ovarian Dropsy Suc- 
cessfully Removed by a Surgical Operation," by Dr. Na- 
than Smith, 1 of Connecticut, Professor of Physic and 
Surgery at Yale College. Mrs. Strowbridge, of Norwich, 
Vermont, aged thirty-three, consulted Dr. Smith regarding 
an enlargement in her right side, which she first noticed 
when it was about the size of a "goose egg,' 1 seven years 
previously. She had born five children. The small en- 
largement excited her attention just after the birth of the 
first, and her application for treatment occurred about ten 
months after the birth of the last. Dr. Smith's diagnosis 
was that the enlargement proceeded from ovarian dropsy, 
and he believed the case to be favorable for an operation, 
involving extirpation of the diseased organ. Accordingly, 
after the necessary preparations, he proceeded to perform 
it in the presence of Drs. Lewis, Mussey, Dana, and Hatch, 
July 5, 1822. He says : " I commenced an incision below 
the umbilicus directly in the linea alba, and extended it 
downward three inches," which exposed the tumor. He 
then punctured the cyst (which proved to be single) with 
a trocar, and drew off eight pounds of a "dark-colored 
ropy fluid." Next, the sac was seized and traction made 
upon it. This brought to light some slight omental ad- 
hesions, which were separated with the fingers and knife. 
" By continuing to pull out the sac the ovarian ligament 
was brought out; this was cut off. Two small arteries 
secured with leather ligatures, and the ligament was then 

1 Am. Med. Recorder, vol. v., p. 124, 1822. 



IN THE UXITED STATES. 



285 



returned," the ligatures being cut off close to the knots. 
The fluid drawn off weighed eight pounds, and the empty 
cyst from "two to four ounces." No sutures were used 
for closing the wound, only adhesive strips and bandage 
being employed for the purpose. Patient completely 
recovered. 

Dr. Smith states that he was led to perform 
the above operation from the fear the patient 
had of a speedy death from the growth of the 
tumor, and from the fact that he had learned 
from an autopsy, and from several specimens of 
dropsical ovaries in his possession, that adhe- 
sions were absent, or so slight as to be of no 
practical consequence in an operation for re- 
moval. He further states that " the operation 
pursued in the above case is the same as I have 
described to my pupils in several of my last 
courses of lectures on surgery. The result has 
justified my previous opinions." Dr. Smith, in 
this connection, refers in a foot-note to the trans- 
lation and publication 1 of the views of Professor 
Dzondi, of Germany, relating to his treatment 
of ordinary encysted dropsy by puncture and 
incision, followed by the use of a tent with the 
expectation of causing mortification and slough- 
ing of the cyst walls, and thus favoring their 
escape through the wound, either spontaneously 

1 Op. Cit., vol. iii., p. 63. 



2 86 MCDOWELL'S OPERATLON 

or by the use of a broad-beaked forceps. He 
says he did not read this article until after his 
operation. In a foot-note 1 published in Dr. 
Smith's Medical and Surgical Memoirs by the 
editor, his son, Dr. Nathan R. Smith, of Balti- 
more, are to be found the following statements: 

"Before the extirpation of the ovarian tumor was accom- 
plished by Professor Smith, as related in the foregoing 
pages, the same operation had been performed successfully 
in Germany. (Here referring, no doubt, to Dr. Chrys- 
mar's operations in Wurtemberg, in 1819, by McDowell's 
long incision.) Of this, however, he had no knowledge, 
and the operations were, therefore, with him altogether 
original. As such it must certainly be acknowledged to 
be of one the boldest achievements of modern surgery." 

In the same publication, and on the same 
authority, Professor Smith is credited with two 
other cases " in which he attempted the opera- 
tion but was compelled to desist." The first 
case referred to was that of a fibrous growth of 
the uterus, and in the second the tumor was 
doubtless an ovarian cyst completely filling the 
abdominal cavity. The latter patient had been 
tapped two or three times previously. The 
adhesions were found so extensive and firm that 
the operation had to be abandoned. In both 
instances recovery followed these unfinished 

1 Dr. Nathan Smith's Medical and Surgical Memoirs, p. 230, 
18*1. 



IN THE UNITED STATES. 2 87 

operations. The editor thus concludes his 
remarks 

" I ought here to state that the same operation has been 
performed in this country in several instances by Dr. Mc- 
Dowell, of Kentucky, and more recently by others. I am 
not confident that the first operation by Dr. McDowell was 
subsequent to that of my father." 

The late Dr. E. R. Peaslee 1 (Dartmouth Col- 
lege, February, 1851), in the report of his first 
case of ovariotomy — one of double ovarian 
dropsy — concludes with the following comments 
upon the case of Professor Smith : 

" Note. — It is a fact, certainly not without interest, that 
the first patient on whom the operation of ovariotomy was 
performed in this country was an aunt of Miss G. (though 
by marriage only), whose case has just been detailed. The 
operation alluded to (being the minor operation") was per- 
formed on the 5th of July, 1820, by Dr. Nathan Smith, 
Professor of Surgery in Dartmouth College, and was suc- 
cessful. The patient was a Mrs. Strobridge, of Norwich, 
Vermont, aet. thirty-three. 

' ' For an account of the case see Medical and Surgical 
Memoirs, by Nathan Smith, M.D., Baltimore, 1831. 

" The year is singularly enough omitted in the report of 
the case. I have ascertained of Dr. H. Hatch, of Burling- 
ton, Vt., who was present at the operation, that it was per- 
formed thirty years ago last July. — E. R. P." 

From the foregoing foot-note it is evident 
that Dr. Peaslee quoted from Professor Smith's 

1 Am. Journ. Med. Sciences, 1851, vol. xxi., p. 321. 



2 88 MCDOWELL'S OPERATLOX 

Memoirs, and not from his first report of the 
case published in the journal cited (1822), two 
years after Dr. Chrysmars five reported cases 
in Germany. 

Results. — One completed operation with one 
cure, and two unfinished operations with re- 
covery. 

Comments. — The author certainly describes 
a plain, simple, and unquestionably successful 
operation, the distinctive features of which would 
seem at first sight to be new and original. The 
claim of originality by the author, however, does 
not rest upon the. first direct and successful ex- 
tirpation of a dropsical ovary without regard to 
previous growth, character, or complications, 
as has been supposed, but upon his first suc- 
cessful employment of an old proposal restricted 
to a short incision, a small tumor of recent or 
simple growth, puncture of the affected organ, 
and reduction of its size in the abdomen with 
extirpation afterward, if possible. In the com- 
bination, therefore, of these several steps is 
seen the revival and remodeling of the proposal 
referred to, embodying the practical extirpation 
of a previously punctured dropsical ovary of 
small size and uncomplicated surroundings ; and 
upon this the author's claim of originality or, 



IN THE UXITED STATES. 289 

more properly speaking, of priority mainly 
turns. 

The short incision now practically applied by 
the author for the first time for the accomplish- 
ment of all these ends in the favorable class of 
cases named was a theoretical proposition of 
Dr. William Hunter, as an extension of the old 
method of incisionism in the lower division of 
the abdomen (1757). The proposal, however,, 
failed to find a supporter for about sixty-five 
years, when it was revived and reduced to prac- 
tice by the author in the way above stated 
(1822) ; this being thirteen years after the de- 
monstration by McDowell of his first direct 
extirpation of a dropsical ovary by the long 
incision made in both the lower and upper 
divisions of the abdomen without regard to pre- 
vious growth, character or complications of the 
existing tumor (1809). The ligation of the 
arteries separately in the pedicle, the use of 
leather ligatures, and the cutting off of the ends 
of the same close to the knots, together with the 
dropping of the divided pedicle into the perito- 
neal cavity, are principles of secondary import- 
ance, and even so only in a limited degree, since 
the proof is conclusive that the author was antici- 
pated in three of these particulars by McDowell, 

!9 



2 qo MCDOWELL'S OPE RATI OX 

who employed silk ligatures on the pedicle in 
mass and likewise on the arteries individually, 
either by bringing- the ends out in the wound 
or by cutting them off close to the knots in both 
cases, and returning the pedicle as circumstances 
demanded. To be sure the author used in his 
selected case a string of leather on the pedicle, 
as a mode of constriction by animal substance, 
with a view of securing more speedy and cer- 
tain absorption, as a supposed advantage over 
a silk ligature. But, while the result was suc- 
cessful and satisfactory in this, his first employ- 
ment of the principle, the practice soon proved 
to be dangerous, without having any real ad- 
vantage over silk, and consequently was aban- 
doned, or used but a few times. 

Dr. Alban Goldsmith (Dr. Alban G. Smith), 
as we have seen, employed an animal ligature 
in one of his three cases, which terminated 
fatally from hemorrhage. This result he attrib- 
uted to the slipping off or the giving way of the 
animal ligature employed. Dr. Bellinger used 
the same kind of ligature once with success. 

The author in the report cf his case (August 
26, 1822) does not make the slightest mention 
of or allusion to the publications of McDowell's 
two papers in the Philadelphia Eclectic Re- 



TV THE UNITED STATES. 2 QI 

per tor t, respectively five and three years pre- 
viously, containing the accounts of the five 
cases operated upon by him between 1809 and 
1S19, which have been previously copied here 
in full. Reference to McDowell's Case III. will 
show the precedent of a medium incision in the 
same situation, perhaps double the length of 
that of the author, easily admitting one hand 
into the abdomen ; and to his Case V., of 
another precedent of a short incision in the 
same locality, admitting one finger, made and 
employed as an exploratory step to complete 
his diagnosis. This case, it will be remembered, 
was one of dermoid cyst, complicated with ex- 
tensive and strong adhesions. Reference to 
McDowell's Case IV. will also show the prece- 
dent of dealing with the arteries individually in 
a very short and spongy pedicle, by "tying up 
the bleeding mouths separately." Not only 
this expedient, which failed of its purpose from 
the soft and yielding nature of the tissues, but 
that of still anotherof far greater difficulty of exe- 
cution, will also be found explained — viz., "the 
arming a needle with a strong ligature," pass- 
ing the ligature " round the ligament (pedicle), 
securing it in its place by taking several stitches 
over its surface," and then tying it firmly. 



292 MCDOWELL'S OPERATION 

Though it is not stated, the natural inference is 
that the ends of the ligature and the sutures 
used to secure it in place were cut off close to 
the knots, as any prudent surgeon would hardly 
have taken the risk (or thought, under the cir- 
cumstances) of bringing out and leaving long 
ends of sutures applied in this way in the lower 
angle of the wound. McDowell's Case V. fur- 
nishes further and even stronger proof of the 
establishment of the same precedent. Here 
were tied "fine cords of silk firmly round each 
of these ligaments " ; and at the autopsy of the 
case, three days after death, it is stated that it 
was found that " the silken cords were securely 
and properly fixed, and not in a situation likely 
to injure the adjoining parts." Such a use of 
fine silk ligatures, and such remarks upon their 
condition and adaptation, as inspected three 
days after their employment, admit of no other 
conclusion than that the ends had been cut off 
close to the knots, and the loops on the pedicle 
left to take care of themselves in the peritoneal 
cavity. 

The question of injustice on the part of the 
author as to the previously published facts con- 
tained in McDowell's two papers is still an open 
one, and one of sufficient importance, there can 



IN THE UNITED STATES. 



293 



be no doubt, to deserve a satisfactory explana- 
tion. Philadelphia, at the time McDowell sent 
there the reports of his five operations for the 
removal of diseased ovaries, to be published in 
the Eclectic Repertory, was the greatest centre 
of medical teaching in this country. The medi- 
cal journal referred to was as respectable and 
widely known as any other then published in 
the United States. Not only had the reports 
of these unique cases in all their details been 
brought to the notice of the large number of 
readers of this periodical, both at home and 
abroad, at the date in question ; but there had 
also appeared from time to time, in the subse- 
quent issues of this journal, sharp criticisms 
upon the teachings of McDowell, as well as 
articles in defence of them, not only by himself, 
but by others. All this, therefore, tended to 
prove beyond question that there was an ex- 
tended knowledge among intelligent and well- 
informed physicians at that period of the great 
triumphs of the Kentucky surgeon. Beside 
this, Professor James, then one of the ablest 
teachers of obstetrics and diseases of women in 
this country (to whom Dr. McDowell directly 
addressed his second paper, September, 1819, 
accompanying it with a dignified and convincing 



294 MCDOWELL'S OPERATLON 

defence of the principles of his operation), 
availed himself of every opportunity to make 
known to his large classes the character of 
these brilliant operations and the influence 
they would have upon the profession. 

While all this was transpiring (including pub- 
lications, criticisms, and discussions) in the 
medical circles of Philadelphia, regarding this 
new operation of McDowell, and even the trans- 
plantation of the same to the little town of Isny, 
in Swabia or Wurtemberg, under the fostering 
care of Dr. Chrysmar, what do we find going 
on in the neighboring city of New Haven, 
Conn., another centre, if not of medical teach- 
ing, certainly of educational and classical in- 
struction ? 

Our author, an able and well-known teacher 
of surgery in Yale Medical College, was also 
directing his attention to the same subject. He 
had completed the cure of a case presenting a 
small cyst by the employment of the Hunterian 
short incision, or by merely the extension of 
McDowell's exploratory incision, puncturing 
the tumor and drawing out its collapsed walls, 
weighing only " two to four ounces." It would 
seem that he had not then heard of the achieve- 
ment of McDowell in having already extirpated 



IN THE UNITED STATES. 2 g$ 

three diseased ovaries by his long incision, as is 
inferred by the failure to mention his name or 
refer to his five published cases. He, however, 
refers in a foot-note to the proposal of Pro- 
fessor Dzondi, in Germany, which had no bear- 
ing whatever upon the operation of extirpation 
of diseased ovaries. The same reference, it is 
proper to mention, is made nine years later 
(1S31) in his Memoirs, by the editor, his son. 
Even the son in this work states : "I am not 
confident that the first operation of McDowell 
(1809) was subsequent to that of my father 
(1822)." In addition, he says that his father 
had since operated in two other cases, but that 
he was compelled to desist in both instances on 
account of the too extensive adhesions, which 
were especially marked in the second case. 
Who can gainsay, regarding the unfinished 
operations in these two cases, that the employ- 
ment of McDowell's long incision, extending 
the entire length of the linea alba (instead of 
this Hunterian short incision, probably the only 
one tried), might not have afforded the requisite 
facilities for obtaining a more complete diag- 
nosis, or at least for getting at and trying to 
overcome the adhesions present, especially in 
the case of the large ovarian cyst, and thus have 



2Cj 6 MCDOWELL'S OPERATION 

effected a completion of the operation, and pos- 
sibly a permanent cure ? 

Case X. — Entitled: "Account of a Case in which an 
Ovarium was Successfully Extirpated" (addressed in the 
form of a letter to a gentleman in Philadelphia), by Alban 
G. Smith, M.D., of Danville, Kentucky. 1 Patient, a 
negress in the neighborhood of Danville, applied to Dr. 
Smith for treatment, with "a diseased and dropsical ovary." 
Operation May 24, 1823. "I commenced," hesays, "by 
making an incision from the umbilicus to within an inch 
of the pubes " (medium incision), which readily admitted 
the hand into the abdomen, and allowed the lifting out of 
the tumor. Turned patient "over on the abdomen (at 
the same time keeping in the intestines with a warm cloth), 
to allow all the blood to escape from the peritoneal cavity." 
Used "a strong ligature of white silk." Ends left long 
enough to be brought out at the lower angle of the wound. 
With " five threaded needles" he "closed the external 
incision by the interrupted suture." On the twenty-fifth 
day ligature came away and patient was discharged cured. 
He found the tumor to be of " a scirrhous appearance, and 
to contain, interspersed throughout its substance, a con- 
siderable quantity of bony matter." It was, no doubt, a 
dermoid cyst. 

In connection with the publication of Dr. 
Smith's case, Dr. Coates — one of the editors of 
the journal quoted — speaks at considerable 
length of Dr. McDowell's five published cases, 
and says : 

" The first instance of which we are aware in which the 
operation was performed by a surgeon for the removal of 

1 North American Med. and Surg. Journ., 1826, vol. i., p. 30. 



IN THE UNITED STATES. 



297 



diseased ovaria is a memorial of the courage of Ephraim 
McDowell, of Danville, Kentucky." 

He also refers to Dr. Nathan Smith's case, 
and to Mr. John Lizars's Anatomical Plates, 
published in Edinburgh, 1825. 

Also in connection with the preceding opera- 
tion of Dr. Smith (subsequently known as Dr. 
Alban Goldsmith), performed in Danville, the 
home of Dr. McDowell, it is proper here to 
refer to the statement of Dr. J. M. Foltz, cor- 
respondent of the New Yo?'k Journal of Medi- 
cine? that Dr. Goldsmith operated in two other 
cases of ovarian dropsy : one a success and 
the other terminating fatally. The latter result, 
on the authority of Dr. Foltz, was attributed to 
the " giving way prematurely " of "an animal 
ligature " and "the supervention of secondary 
hemorrhage within the abdominal cavity." 
These two cases have never been published in 
detail. Dr. Foltz further credits Dr. Goldsmith 
with the statement that he saw a patient with 
Dr. McDowell, in Danville, who " had tapped 
herself no less than ninety times," and who 
presented herself to Dr. McDowell for the ex- 
tirpation of the supposed tumor. "The event, 
however, proved, much to the surprise of the 

1 Vol. i., Sept., 1843. 



298 MCDOWELL'S OPERATION 

two surgeons, that the tumor was merely a mass 
of the intestines conglomerated by adhesions." 

Results. — Three completed operations with 
two cures and one death; mortality, ZZVs P er 
cent. 

Comments. — The author, although at one 
time a partner and an assistant of Dr. McDow- 
ell in his earlier operations, strange to say, does 
not mention or allude to him in the slightest 
way in the report of his case. The distinctive 
features of the operation performed by him, 
however, are precisely the same as in McDow- 
ell's, and he found in this case that the medium 
incision of the latter, below the umbilicus, was 
sufficient for the removal of the tumor. The 
ends of the pedicle ligature were brought out 
at the lower angle of the wound, which was 
closed with interrupted sutures, compress, and 
bandage in the usual way. 

The author, according to Dr. Foltz, as we 
have seen, performed two other operations after 
this, one being completely successful, and the 
other terminating fatally in consequence of the 
giving way of an animal ligature employed for 
securing the pedicle. 

Case XI. — Entitled : " Successful Operation for Ovarian 
Disease." By R. D. Mussey, M.D., then of Dartmouth, 



IN THE CXI TED STATES. 299 

N. H.,and afterward of Cincinnati, Ohio. 1 Mrs. Sly, of 
Ryegate, Vt., aged forty, consulted Dr. Mussey in the 
summer of 1828. She presented a tumor in the left side of 
the abdomen, which was first noticed one year previously. 
Dr. Mussey's operation was made in July, 1828. " An inci- 
sion was made through the integuments, at the linea alba, 
from the umbilicus to the symphysis of the pubis. ' ' He found 
the tumor covered " by the mesocolon, the transverse colon 
being situated below the tumor, extending from iliac to iliac 
regions. All that could be safely attempted was to dis- 
charge the fluid, and take measures to inflame the interior 
surface of the cyst." Through "one of the meshes of the 
beautifully injected mesocolic vessels a puncture was made 
large enough to admit a catheter, by which the fluid, 
slightly turbid, and amounting to between four and five 
pints, was drained off. The opening was then enlarged, 
and a tent of twisted charpie introduced a little way into 
the sac, the other extremity being left to hang out exter- 
nally." Usual treatment of the wound by sutures, com- 
press, and broad band around the abdomen. At the end of 
" three weeks the discharge was trifling, and the opening 
speedily closed." Patient, about a year afterward, gave 
birth to " her fourteenth and last child." 

Dr. Mussey published this case about nine 

years after the operation described, and he says 

he saw the patient about two years prior to this 

date (1837), at which time she was well, thus 

proving the probability that the tumor was a 

fibrocystic growth, and not an ovarian cyst. 

His convictions at the time of reporting the case 

were that when a tumor "is wholly or in part 

fleshy," and presenting grave complications, 

^mer. Journ. Med. Sciences, 1837, vol. xxl., p. 380. 



3 00 MCDOWELL'S 0PERATL0N 

such for example as here existed, no sort of 
operation for removal is practicable " without 
subjecting the life of the patient to imminent 
hazard." He further says: "I could cite four 
cases of this kind, and, if proper, could desig- 
nate the several operators, who thus gave them- 
selves occasion to repent of their temerity." 

Comments. — In connection with the author's 
case, it is proper to state that although he was 
present at the first operation of Professor Na- 
than Smith, in the case of Mrs. Strowbridge, 
in 1822, and therefore had had some practical 
knowledge from direct observation, he did not 
employ the short incision used by him. Among 
the four cases of unfinished operations in the 
hands of other surgeons, to which he refers, he 
probably had in mind the two unfinished opera- 
tions of his colleague, Professor Smith, which 
were brought to the notice of the profession by 
his son, Dr. Nathan R. Smith, in 1 831, as has 
been mentioned. I will add that Dr. Mussey 
makes not the slightest reference to Dr. Mc- 
Dowell or his operations. 

Case XII. — Entitled : " Case of Ovarian Tumor Suc- 
cessfully Extirpated." By David L. Rogers, M.D., New 
York. 1 The patient, Mary Gurly, consulted Dr. Rogers in 
regard to a large tumor in the left side of the abdomen about 

1 Med. and Physical Journal, Jan. 1830, vol. ii., p. 284. 



IX THE UNITED STATES. • 30 1 

two months before his operation. She had been tapped five 
times, and the quantity of fluid drawn off was computed at 
about eighteen gallons. Operation September 14, 1829. 
Present, Drs. Mott, Vache, and J. H. Rogers. He 
says: " I commenced an incision a little below the ensi- 
form cartilage, carrying it parallel with the linea alba, and 
terminating at the symphysis pubis." The adhesions were 
somewhat extensive : "some separated by the finger, others 
by the handle of the scalpel. After occupying two hours 
in the operation, the huge mass of disease was safely re- 
moved and laid on the table." The ligatures on the 
bleeding vessels and pedicle were all cut off close to the 
knots and left to absorption. "The wound was closed by 
sutures, dressed with adhesive strips, lint, a compress, and 
a bandage applied firmly to the abdomen." One-third of 
the tumor was solid, containing a fibro-cartilaginous sub- 
stance. 

In connection with the history of the operation 
Dr. Rogers says : 

" Dr. McDowell, of Kentucky, has reported three cases 
in which he operated successfully for tumors in the abdo- 
men, ovarian and hydatid. A doubt exists in relation to 
these cases, and certainly the mode of describing them is 
calculated to confirm that doubt. We are bound, how- 
ever, upon the authority of others, to believe them, not- 
withstanding the improbabilities connected with their 
details ; and it is much to be regretted that a more cir- 
cumstantial account of these cases has not been given to 
the profession." 

Dr. Rogers then refers to Dr. Nathan Smith's 
case and its result ; concluding his report with 
the following statement of statistics : " Thus we 
find in the twelve operations that have been 



302 MCDOWELL'S OPERATLON 

performed for the removal of this disease, 
seven have been successful, and two remained 
doubtful." 

Comments. — The author in the description of 
his operation clearly shows that he had studied 
well the operations of McDowell and followed 
his method to the letter ; using silk ligatures 
for the pedicle and bleeding vessels, cut off close 
to the knots, as McDowell did in Cases IV. and 
V. It appears a little strange that the author 
should have limited his reference and criticisms 
to McDowell's first three cases, treated by 
bringing out the ligatures in the lower angle of 
the wound, not making the slightest mention of 
his second paper, containing the report of his 
fourth and fifth cases. It must, however, be 
added to the author's credit that he was the 
first of the four surgeons in this country, who 
had up to this time undertaken the operation 
for extirpation of the ovary, to make any refer- 
ence whatever to the teachings of McDowell. 
Another interesting fact deserving of mention 
is, that this case was the last one operated upon 
and published in the United States prior to the 
death of the "Father" of the operation, which 
occurred at his home, Danville, Kentucky, June 
25, 1830. "A prophet is not without honor 



■if 



IN THE UNITED STATES. 



303 



save in his own country," does not apply in this 

instance, at least. 

Case XIII. — Entitled: "Tumor of the Ovarium," by 
J. C. Warren, M.D., of Boston. 1 Dr. Warren, in the pre- 
sentation of this subject, calls attention to " two kinds of 
ovarian enlargement,", viz. : "scirrhous and dropsical." 
In illustration of the former variety he cites a case, that of 
Catharine Wait, single, aged forty, admitted to the Massa- 
chusetts General Hospital, October 28, 1830. The patient 
had noticed a tumor in her right side four years previously, 
and her catamenia had been profuse. Dr. Warren per- 
formed the operation for removal of this tumor November, 
1830. "An incision was carried from above downward 
through the linea alba, the length of twelve inches." A 
" broad adhesion " was found in " the lower part " of the 
abdomen, and it "was encircled by a thick ligature." 
Under this "ligature a needle with a double thread was 
carried through the adhesion and tied on each side. The 
adhesion was then cut, and the tumor removed. Owing to 
the shortness of the pedicle the ligature partially slipped 
off as soon as the scirrhus was taken away, and though the 
vessels were secured as fast as possible, they were so num- 
erous and large that the patient in a short time sunk from 
loss of blood." The tumor weighed " about twenty-five 
pounds," and was "of almost cartilaginous hardness." 
Dr. Warren concludes his remarks on this case and the 
result of the operation in these words : " The event of this 
case has led me to decline repeating the operation ; and I 
should advise others to decline it unless there were some 
peculiar insulation of the tumor, as when it formed a hernia 
or when it had a very long and narrow pedicle." 

Of the dropsical variety of ovarian tumors 
Dr. Warren goes on to state that he had met 

1 Surgical Observations on Tumors, with Cases and Operation, 
1839. 



304 MCDOWELL'S OPERATION 

with one case, that of a lady who had undergone 
three tappings. Soon after the third she died, 
and the autopsy revealed a cyst with walls a 
quarter of an inch thick and filled with hydatids. 
Comments. — The author in his operation cer- 
tainly encountered grave difficulties, and per- 
haps met them as courageously as any one else 
at that time could have done ; but the trouble 
at the outset was unquestionably an error in 
diagnosis as to the true character of the tumor, 
and not due to any fault of the operation by 
McDowell's long incision, which was employed, 
though no mention is made of the latter sur- 
geon. The facts of the case prove that the 
tumor was a pedunculated fibroma of the uterus, 
somewhat similar to Case IV. of McDowell's 
record, which presented a like difficulty in the 
management of the pedicle, though with a far 
different final result. In the dropsical variety 
of ovarian tumors, as described in this same 
connection, the author would probably have 
been more successful in the employment of the 
operation, and would have had less cause for 
condemning it. This want of experience as to 
the diagnosis of the different varieties of tumors, 
both previously to this and for some time after- 
ward, proved more prejudicial than anything 



IN THE UNITED STATES. 



305 



else to the acceptance of the teachings of 
McDowell. 

Case XIV. — Entitled: "Extirpation of an Ovarian 
Tumor, Complicated with Hydrops Uteri — Recovery." 
By John Bellinger, M.D., Charleston, S. C. 1 Patient, 
a negress, aged thirty-five, first noticed in 1834 a round 
tumor in the right side of the abdomen. Applied to Dr. 
Bellinger for treatment about a year later. He performed 
the operation for the removal of this tumor December 23, 
1835, in the presence of Drs. Dixon, Prioleau, and Ogier. 
"The subject being corpulent the incision was commenced 
above the umbilicus, and extended to the symphysis pubis"; 
afterward "continued nearly to the ensiform cartilage." 
No adhesions mentioned. Pedicle divided. " Two arteries 
of considerable size required tying ; animal ligatures were 
applied and both ends cut away near the knots." Patient 
recovered. Tumor fibrous, with "the dimensions of a 
medium-sized fist." 

Comments. — The author in his title indicates 
the removal of an ovarian tumor, but after its 
removal describes it as a fibrous growth — a 
discrepancy that may appear singular, though 
it was not an unusual thing for writers to do 
even many years after the date of this opera- 
tion ; a habit resulting, no doubt, from the 
belief that the operation, as proposed by Mc- 
Dowell, was intended solely for the removal of 
the former variety of tumors, and not for the 
latter. The author makes no mention of Mc- 

1 Southern Journal of Medicine and Pharmacy, May, 1847, 
p. 241. 
20 



306 MCDOWELL'S OPERATLON 

Dowell in the report of his case, though he em- 
ployed his long incision, with a full understand- 
ing of its advantages for securing access, light, 
and freedom of manipulation, even for the re- 
moval of a tumor so small as the one found to 
exist. 

After this the operation fell into total neglect 
in the United States for eight years, only the 
above and the preceding operation being per- 
formed during the thirteen years intervening 
between the death of Dr. McDowell and the 
time of the revival of the operation here by the 
late Dr. John L. Atlee, of Lancaster, Pa., one 
year after the latter occurred in England 

(1842). 

Summary of cases and results in the United 
States, including the two cases of Dr. Nathan 
Smith referred to by his son, Dr. Nathan R. 
Smith, and the two cases of Dr. Alban G. Smith 
referred to by Dr. Foltz, but not here brought 
out in detail, making in all 18 cases — 12 com- 
pleted operations with 9 cures and 3 deaths ; 6 
unfinished operations with 6 recoveries. Mor- 
tality of completed operations, 25 per cent. 



IN FRANCE. 207 



SECTION II 

France. 



The history in France of tapping and inci- 
sionism, with injections and drainage, as means 
of relieving and curing encysted dropsy of the 
ovary, may be said to be extensive as compared 
with that of other countries ; and the modern 
writers entitled to most consideration upon the 
subject are Lisfranc, Velpeau, Vidal, De Cassis, 
and Malgaigne. It is not my purpose here to 
attempt a review of all the interesting points 
connected with these several subjects brought 
out by these authors, but simply to indicate, by 
a few brief extracts, how the first proposal of 
extirpation of a dropsical ovary, as an advance 
upon former teachings, came to be made, and 
how the principle was regarded afterward. Lis- 
franc, in connection with his discussion of inci- 
sionism, speaks of the importance of effecting 
artificial adhesion between the dropsical ovary 
and the abdominal wall by the employment of 
caustic potash over the point of election for the 
operation, as a preparatory measure, when a 
close relationship of the parts had not already 
taken place from the existing disease, a condi- 



308 MCDOWELL'S OPERATION 

tion of things desirable for the operation, being 
similar to that met with in abscess of the ovary. 
He says, however, that he had seen, and even 
himself tried, the expedient referred to, but it 
was uncertain ; and at best it usually failed of 
its purpose, viz. : to prevent the fluids contained 
in the cyst from escaping into the peritoneal 
cavity, and causing injurious consequences. In 
speaking of extirpation of the ovary itself, when 
in a dropsical condition, accompanied by scir- 
rhous degeneration, he said the proposal was 
based upon the safety of the practice that had 
long before existed among certain peoples in the 
East of removing the normal ovaries, upon 
which he comments as follows : 

" Plater, Delaporte, Morand, Diemebroeck, Darwin, 
veulent qu'on pratique l'extirpation de 1'afTection morbide, 
lorsque l'hydropisie de 1'ovaire est accompagnee d'une 
degenerescence squirrheuse, ou bien quand la tumeur est 
composee de plusieurs loges qui ne communiquent pas 
entre elles et qui ne permettent pas de la vider ; ils pensent 
que cette operation peut etre faite, puisqu' on y a recours 
presque sans danger sur les femelles de plusieurs animaux 
qu' on veut rendre steriles; Athenee et Suidas rapportent 
qu'Adrometes et Gyges faisaient pratiquer T ablation des 
ovaires a beaucoup de femmes, pour qu'elles n'eussent pas 
d'enfants; on dit que cette inhumaine et criminelle cou- 
tume a existe chez quelques peuples de 1' Orient ; on parle 
d'un chatreur qui, ayant concu des soupcons sur la vertu 
de sa fille, lui enleva les deux ovaires, apres avoir incise la 
paroi de l'abdomen ; on assure que cette jeune fille guerit." 



IN FRAXCE. 309 

Notwithstanding the facts presented he 
further adds : 

"The extirpation of ovarian cysts is rejected by Dehaen, 
Morgagni, Sebatier, Gardien, and others. Lemaunier, 
Smith, Lizars, Macdowel, Chrysmar, Delaporte, Lieutaud, 
and others, have extirpated the disease in question with 
success. It is likewise known that some of the women 
operated upon by Lizars, Martini, and Chrysmar, died, and 
most of them only a few hours after the operation ; and 
how many cases, it may be asked, died, and have been 
passed over in silence ? We are not ignorant of the cases 
of Lizars, Granville, Dieffenbach, and others, whose opera- 
tions were abandoned after they opened the peritoneal 
cavity, because of the existence of too numerous and strong 
adhesions, and too great a vascularity of the parts ! " l 

Velpeau and Vidal discuss the old method of 
incisionism for treating dropsical ovaries very 
much in the same manner as Lisfranc, and their 
views, consequently, do not call for special con- 
sideration. Of Velpeau, however, it may be 
said that he is, on all matters relating to scien- 
tific progress, of the highest authority, and is, 
generally, accurate and comprehensive in his 
reference to authors. For this reason a short 
quotation is made from him, the passage pur- 
porting to be a reflex of the history of the pro- 
posals of extirpation of the disease in question 
in all countries for over a century (172 2-1 840) : 

1 Clinique Chirurgicale de l'Hopital de la Pitie, 1841. Tome 
iii., p. 710, 



3io 



MCDOWELL'S OPERATLON 



11 Extirpation was already discussed by Schlenker (1722), 
Willius (1731), Peyer (1751), Targioni (1752), and prac- 
ticed by Frankenau 1 and Percival-Pott 2 . Extirpation of 
the ovary had also, as previously stated, occupied the atten- 
tion of Delaporte, who, becoming discouraged from his 
experience in the employment of the old method by inci- 
sionism, asked himself if it would not be better to extirpate 
the diseased organ. This idea was seized upon and ex- 
tolled by Morand 3 , who, after reflection, thought the opera- 
tion should be performed, but early. Near the same epoch 
Theden proposed the method that bears his name, which 
was strongly defended by Power and Darwin, two English 
surgeons. Nevertheless, their efforts, joined to those made 
later by M. d'Ischier/ were not sufficient to make this opera- 
tion acceptable. Notwithstanding the success obtained by 
Laumonier, notwithstanding the cure of Mme.de Choiseul, 
and notwithstanding the happy issue of the operation 
reported by Kapeler, Morand's idea of extirpation of the 
ovary remained without practical application until 1825, 
when Mr. Lizars called anew the attention of the profession 
to the subject. 5 Also, with more confidence did Drs. 
McDowel, and Nathan, and Alan Smith, 6 put it to the 
test in America. In Germany Dieffenbach and Chrysmar 7 
sought to make it prevail, and in England the surgeons of 
that country regarded it very favorably." 8 

As there has always been, and still is, a mis- 
understanding, out of France, as to the facts 

1 Satiras Mydicse, p. 41. 

2 (Euvres Chirurg., t. i., p. 492. 

3 Memoires de l'Acad. de Chirurg. t. ii., p. 460. 

4 These de Montpellier, 1807. 

5 Bulletin de Ferussac, t. iv., p. 144. 

6 Journal des Progres, t. v., p. 273. 

7 Bulletin de Ferussac, t., xviii., p. 86. 

8 Dictionaire de Medecine, t. xxii., p. 590, 1840. 



IN FRANCE. 



311 



relating- to the first proposal of extirpation of a 
diseased ovary in that country, and as to the 
claims of priority in the operation, incorrectly 
ascribed to surgeons there, I have deemed it 
proper to premise my presentation of the sub- 
ject by the foregoing quotations from authors of 
acknowledged authority. This I have done in 
order that I mieht be able to examine the facts 
which are to follow more carefully and connect- 
edly, and thereby to remove, if possible, the mis- 
understanding referred to among writers. This 
misunderstanding and the discrepancies arising 
therefrom, and existing for so many years in all 
countries, even in France, as shown from what 
has already been brought out, have proved most 
prejudicial to McDowell's claims of originality, 
the defence of which is the object of this investi- 



gation. 



Incisionism. — My plan now of presenting the 
subject is to bring out, in the first place, all that 
relates to the employment in France of the old 
procedure of incisionism for the relief and cure 
of encysted dropsy of the ovary, as immediately 
preceding the proposal there of extirpation of 
the diseased organ. This old procedure is gen- 
erally supposed to have first originated in that 
country, but the facts do not support the claim. 



312 MCDOWELLS OPERATIOX 

The credit of the first employment of incisionism 
is unquestionably due to Great Britain, the 
earliest case on record being that of Dr. Robert 
Houston (1701), as I shall show later on. 

The surgeons to whom I shall particularly 
refer in connection with the employment of the 
method of incisionism for the treatment of drop- 
sical ovaries, and the proposed extension of it 
to the procedure of extirpation of the diseased 
organ itself, are Le Dran, Delaporte, and 
Morand. The reports and comments upon the 
subject by these three surgeons (the first named 
in relation to incisions, with injections and a 
drainage tube, and the other two to incisions 
and extirpation) are found given at consider- 
able length in an analysis based upon the 
Memoires de l'Academie Royale de Chirurgie, 
and published under the title : Plusieurs Me- 
moires et Observations sur U Hydro pisie En- 
kystee et le Squirrhe des Ovaries. Par M. 
Marjolin. 1 

These Memoires comprise seven cases of 
encysted dropsy of the ovary, but only such 
cases as serve to illustrate the subject will be 
introduced at length, two by Le Dran, and one 
by Delaporte. The other four cases, though 



v 



ncyclopedie des Sciences Medicales, 1837, t. 39, p. 50, 



IN FRANCE. 3 t 3 

illustrating some interesting features of the dis- 
ease in question, are only incidentally and briefly 
referred to, as showing dates and the way in 
which the pathology of such cases was generally 
regarded by physicians at that period. 

Le Dran (i 736). — Report entitled : Encysted- 
Dropsy Treated by an Operation from which a 
Fistula Remained — begins by pointing out the 
differences between general dropsyand encysted 
dropsy. Next, in illustration, he describes a 
case of abdominal distension for which he tapped 
the patient twice, at an interval of three or four 
months. He drew off the first time ''thirty-six 
pounds of fluid, which was of a muddy color, 
and had a bad odor," and which, after standing 
for a day, deposited " from fifteen to sixteen 
ounces of blood, in the shape of small clots." 
The second time he drew off about the same 
quantity of fluid, and it was of a like quality. 
The patient had almost all the time a continued 
fever, more or less brick-dust deposit in the 
urine, and general pelvic and abominal pains, 
together with other symptoms not commonly 
met in general dropsy. She died in twelve days 
after the second tapping. The autopsy dis- 
closed the existence of "a large number of 
scirrhous tumors in both iliac fossae," with a 



o l4 MCDOWELL'S OPERATLON 

defined cyst within the peritoneal cavity, firmly 
adherent to the parietes of the abdomen in 
front and on the sides, thus cutting off from view 
all the abdominal and pelvic viscera, and caus- 
ing the cavity to appear as if " all its contents 
had been removed." Le Dran describes the 
abdominal cavity as being lined by the walls of 
a great cyst, varying from two to four lines in 
thickness, and constituting a part of the ''scir- 
rhous tumors" discovered in the " iliac fossae." 
He found that this patient was relieved for a 
time after each tapping, and he was, therefore, 
led to conclude "that if the cyst in such cases 
could be prevented from refilling" a cure might 
be effected, or, at least, life be prolonged by it. 
He cites a similar case, reported by Wander- 
viel, which was treated by Nuck. From his 
experience and study of the subject Le Dran 
was led to try the plan of treatment indicated 
in the title and outlined in the following case: 

September, 1736, a woman, aged sixty, presented herself 
with an abdominal tumor, first noticed eighteen months 
previously, and suffering considerable discomfort from its 
gradually increasing size. It was found fixed in the hypo- 
gastric region, extending up from both iliac regions, par- 
ticularly the left, rounded like a distended bladder, and 
reaching as high as the umbilicus. Fluctuation was indis- 
tinct, owing to its hardness, especially on the left side. 
Le Dran .expressed the opinion that the tumor should be 



IN FRAXCE. 



315 



opened "in a good part of its extent the length of the 
linea alba" below the umbilicus, to prevent its refilling, 
but the physician in attendance objected to the procedure, 
claiming that it was better first to tap the patient, to see 
whether there were "any scirrhous masses in the sac when 
emptied." Accordingly, the patient was allowed to go on 
until January, 1737, when the tumor had extended up to 
the diaphragm, and she was tapped by the physician in 
charge, fifteen pints of sanguinolent fluid being drawn off. 
Seven weeks later (February) she was tapped a second time, 
in the right side, when twelve pints of fluid escaped, the 
canula being now allowed to remain in the cyst to insure 
drainage. M. Le Dran saw the patient two days after- 
ward, when he found a little purulent fluid escaping 
through the tube, and the left iliac region "filled by a 
scirrhous tumor. Its situation and its rounded outline 
seemed to indicate that it was the ovary, which had become 
swollen and scirrhous, as is often observed." The tumor 
now was so much larger than when he first saw the case 
(six months previously) that he did not have as much hope 
of curing it by his proposed plan of treatment, to wit, by 
incision and the setting up of inflammation and suppura- 
tion of the sac. Nevertheless, he proceeded to enlarge the 
trocar opening in the right side. This he did by introduc- 
ing a grooved director, and making upon it an incision 
downward four inches in length, thus laying open the 
abdomen. On introducing his finger, however, he could 
not feel the cyst-wall. At first the edges of the wound 
were kept apart with charpie, afterward by means of a 
tube made of sheet lead, through which direct drainage was 
effected, and injections made night and morning. For 
four weeks there was considerable discharge, intermixed 
with shreds of the cyst-walls, as was supposed, through the 
drainage-tube ; but this gradually grew less and less, and at 
the end of about five months after the first opening was 
made (the drainage-tube having been left off) a fluctuating 
tumor was found in the hypogastric region. A somewhat 



316 



MC D O WELL'S OPERA TION 



transverse incision, six to seven inches in length, was now 
made from the original point of puncture in the right side, 
in the direction of the axis of the tumor, four fingers' 
breadth above the pubes. "A part of the right rectus 
muscle, and all of the left, together with the oblique and 
transverse muscles of this side, were cut through." In the 
operation the left epigastric artery was divided, and had to 
be tied. Two pints of fluid, of a sanious character, first 
escaped, "and then another pint of a different nature came 
from the left iliac fossa." On passing the hand into the 
latter region the tumor present six months previously 
could not now be felt. The wound was stuffed with lint, 
which was removed as often as necessary, the drainage tube 
after a time being made to take its place. The wound healed 
in seven weeks, leaving a fistula. The patient lived four 
years. At the autopsy the cyst was found "shrivelled up," 
and having a fistulous outlet, and the intestines were seen 
to be matted together, adhering to the cyst-walls at several 
points. "Scirrhous tumors of various sizes, and adherent 
one to another," were found in the intestinal mass and in 
the hypogastric regions. 

M. Le Dran drew the following conclusions 
from this case : 

"Encysted dropsy of the abdomen is almost always 
caused by a scirrhous tumor, and is developed from it. 
The cyst, however small, is always full of fluid. Encysted 
dropsy can only be cured by a large incision in the 
cyst. The cyst must be opened early. It is not suffi- 
cient to make a simple puncture with a trocar, but the 
opening must be of sufficient size that the cyst may sup- 
purate before the incision closes. Though this mode of 
cure is only palliative, it ought to be practised, for it pro- 
longs life." 

M. Le Dran's second case. Report entitled : 



IN FRANCE. T )l y 

" Encysted Dropsy Cured by Incision ; No Fis- 
tula remaining." 

In 1746, a woman, aged forty-two, after having general 
derangement of her health and abdominal enlargement for 
two years, consulted M. Le Dran, who tapped her and drew 
off " fifteen pints of a muddy, foul-smelling fluid." After 
the cyst was emptied he was able " to make out a scirrhous 
tumor, about the size of a melon, in the left iliac fossa." 
He says that after three weeks the sac had refilled, and was 
as large as it was at the first tapping. Next comes an 
account of M. Le Dran's operation, and his explanation of 
its adaptation to the case. "An incision was made in the 
linea alba, a little below the umbilicus, of sufficient length 
not to close up promptly, so that the lower angle of it 
would always be near the bottom of the sac as the latter 
contracted and approached the scirrhous tumor. A large 
canula was placed in the incision to prevent its closure, 
and to allow of suitable injections being made." After the 
operation the patient had nausea and vomiting, followed by 
fever and delirium, which lasted three weeks, during which 
time the stomach would retain only Spanish wine. During 
this period "six to eight ounces of a reddish, muddy liquid 
escaped daily through the canula," after which this liquid 
became clearly purulent. "Finally, one morning, when 
twelve to fifteen ounces of clear white pus suddenly escaped, 
it was thought that the scirrhous tumor had begun to sup- 
purate, and that its contents had discharged." The patient 
from this time on rapidly improved in strength, and the dis- 
charge of pus gradually diminished, so that at the end of 
six months only a teaspoonful a day escaped. This slight 
drainage went on for three years, at the end of which time 
the drainage-tube escaped, and the patient could not return 
it, whereupon the fistula soon closed, and the patient con- 
tinued completely cured. 

Here follow the reports of four other cases of 



318 MCDOWELL'S OPERATLON 

encysted dropsy and scirrhous ovaries, 1 one by 
M. Mouton (1731), the case of a woman, aged 
thirty-nine, presenting an encysted dropsy be- 
tween the peritoneum and the abdominal mus- 
cles. This woman had consulted a number of 
surgeons regarding her case during the pre- 
vious two years, and finally M. Boudou, of Paris, 
but she would never consent to be tapped. She 
died February of the same year. The interest- 
ing point is that during the last two weeks of 
her life she was only able to rest in her bed 
upon her knees, and literally " fell dead." The 
dimensions of her body were simply enormous, 
the girth being six feet seven inches, and the 
distance from the ensiform cartilage to the pubis 
three feet four inches. At the autopsy the cyst 
was found in the abdominal wall, as stated, to 
contain sixty pints of fluid, of the color and con- 
sistence of the dregs of wine. ' No fluid was 
found in the peritoneal cavity, the organs there 
all being found healthy. 

One case of encysted dropsy of the perito- 
neum, by M. De La Chaud. This patient was 
tapped three times, the quantity of fluid dimin- 
ishing from twenty to ten pints at the third 
operation. At the autopsy the cavity contain- 

1 Op. Cit. 



W FRAXCE. 



319 



ing the fluid was found to be between two folds 
of the peritoneum. 

One case of dropsy of the ovary, by M. Mon- 
taulieu. The woman was aged forty-five, and 
had been tapped nineteen times in eleven 
months. She died March 13, 1732. The 
autopsy showed a large cyst filling the entire 
abdomen, with but few adhesions, and found 
connected with the left ovary. Here, on the 
inside of the cyst, were "several masses of 
scirrhous and ulcerated tumors" of a " cauli- 
flower form," no doubt of a papillomatous 



origin. 



One case of scirrhus of both ovaries, com- 
plicated with general dropsy, by M. Malaval. 
The patient, at the age of forty, began to notice 
distinct enlargements on both sides of her 
abdomen, which developed into two round and 
smooth tumors, easily felt through the abdo- 
minal wall, and which would fall from side to 
side as she turned in bed. When this woman 
consulted M. Malaval there was uniform disten- 
tion of the abdomen, but not great enough to 
demand tapping, and the patient, having taken 
the ordinary remedies without effect, soon after- 
ward died. The autopsy showed a small col- 
lection of fluid in the peritoneal cavity, and the 



320 MCDOWELL'S O PER ALL ON 

presence of the two tumors (ovarian) previously 
diagnosticated, one weighing twelve pounds and 
the other fifteen pounds. The parietal adhe- 
sions were slight and easily broken up. 

First Proposal of Extirpation of a Drop- 
sical Ovary. — Next we come to the unique 
and classic case of this series, entitled "En- 
cysted Dropsy of the Ovary Treated by Incis- 
ion," by M. Delaporte. 

A woman, aged fifty-seven, having "an enormous ab- 
dominal dropsy," consulted Delaporte. Fluctuation was 
found to be indistinct, being felt only as an undulatory 
wave, which was accounted for by the cedematous condi- 
tion of the abdominal walls. Under these circumstances 
Delaporte introduced a trocar, but no fluid escaped. A 
probe introduced through the canula and withdrawn "was 
found covered with a thick gelatinous mass." 

Here follows the description of the operation 

by Delaporte and his comments upon the 

result : 

" On the following morning a grooved trocar was intro- 
duced a few fingers' breadth above the anterior spine of the 
ilium of the left side, and an incision, five finger-breadths 
in length, and running obliquely upward toward the rectus 
muscle, was made through the abdominal muscle, the peri- 
toneum, and the wall of the underlying tumor. Through 
this incision suddenly issued a mass of matter resembling 
jelly, about the size of a child's head, and in the course of 
two and a half hours thirty five pounds escaped. Then a 
dressing was applied, and on changing this fifteen pounds 
more escaped. The next evening the incision had con- 



IN FRAXCE. o 2I 

tracted very much. The following morning the wound 
was enlarged upward, and five or six pounds of jelly again 
escaped. This was on the third day after the first opera- 
tion. During the night of the third and fourth day the 
patient was attacked with profuse diarrhoea. On the night 
of the fourth and fifth day much sanious fluid escaped 
through the incision. During the night of the fifth and 
sixth day the same jelly-like fluid escaped, and in the 
morning the wound was covered with an eschar. The 
diarrhoea persisted, and fever set in. The tenth day after 
the operation about a pound of jelly escaped through the 
wound. The patient died from exhaustion on the thirteenth 
day after the operation, after having furnished in all sixty- 
seven pounds of this gelatinous material. On opening the 
abdomen a large encysted tumor was found occupying 
almost the whole of the abdominal cavity as far as the right 
hypochondrium. On following up this tumor it was found 
to start from the right ovary. The tube and broad liga- 
ment on that side were merged with the tumor. The ovary 
on the left side was perfectly healthy. If the operation 
had been done earlier would it not have been possible to 
prevent the growth of the tumor, and consequently the 
accumulation of such a quantity of fluid ? Supposing that 
this operation should not prove successful, would it not 
be possible to remove the focus of the disease — namely ', the 
tu?7ior formed by the ovary ? ' ' (The writer's italics. ) 

M. Morand makes comments upon the fore- 
going cases somewhat in this manner: He 
recognizes the two forms of general and en- 
cysted dropsies, and states that the latter is 
much more common than is generally believed. 
He refers to an unique case of it published in 
the Royal Academy of Sciences, in 1718, and 
says that "the cyst, with very delicate walls, 



322 MCDOWELL'S OPERATLON. 

was found floating free in the peritoneal 
cavity" ; but that there was a different variety, 
not uncommon, such as the one described by 
M. Delaporte. He states that the tunics or 
coats of the ovary constituted the walls of the 
cyst, and that the latter admitted of prodigious 
dilatation. The cavities of these cysts were 
frequently the seat of "scirrhous masses," 
lining the walls more or less extensively, and 
the growth of the cyst was influenced largely 
by the presence of these. He says that the 
encysted dropsy of the ovaries may be distin- 
guished from general dropsy by its occurring 
in one or the other of the hypogastric regions ; 
and that it is only when the growth has attained 
sufficient size to fill the abdomen that the diag- 
nosis is obscure. He recognizes the coexist- 
ence of pregnancy as a complication of en- 
cysted dropsy, and refers to a case where the 
general health underwent but little change dur- 
ing three terms of pregnancy, the patient 
suffering very little from the complication until 
the third, when it failed to reach full term. 
Tapping in this case was made at the end of 
the fourth year, and twenty-five pints of fluid 
drawn off. He points out the difference in the 
quality of the fluid found in the two forms of 



IN FRANCE. 223 

dropsy, and lays great stress upon the consist- 
ency or thickness of the fluid in encysted 
dropsy of the ovary, which he assigns as a rea- 
son for the indistinctness of fluctuation fre- 
quently met with, and the consequent failure 
to detect it in many instances. As to the mode 
of treating encysted dropsy, he concludes his 
comments in the following words : 

" It is a question if the proper treatment of these cases 
is not the free incision of the cysts. M. Le Dran is per- 
fectly right in counselling the operation before the tumor 
has reached any great size. M. Delaporte operated too 
late, and rather with a view to improve the patient than to 
cure her. 

" The incision is not as useful in cases of ovarian dropsy 
complicated by scirrhous tumors within the sac ; the rea- 
sons for this are obvious. 

"M. Delaporte ought to be praised for first enunciating 
the idea of removing the ovary at the same time the fluid 
is removed. It is true, it would not be an easy operation 
when the cyst has formed many adhesions, but it ought to 
be attempted early." 

Soon after the period (1750) Delaporte 
suggested extirpation of the ovary, for the cure 
of encysted dropsy of the organ, Theden pro- 
posed a method of operating that bears his 
name, and which we find described in the 
Encyclop&die des Sciences Midicales, 1 as follows : 

1 3 Division Chirurgie Medecine Operatoire, par Malle, 1841, 
t. 19, p. 919. 



324 



MCDOWELL'S OPERA TION 



" He commences by making an incision in the inguinal 
region, extending it through the skin aud muscles down to 
the cyst, which, according to his idea, is outside of the 
peritoneum. He then dilates the wound with the fingers, 
taking care to control the bleeding vessels. This being 
done, he separates the edges of the wound from the cyst, 
and by an incision into the latter gives vent to the con- 
tained fluid. He finishes this step by detaching and draw- 
ing out the emptied sac. Next, with a long silk thread, 
with the ends to project beyond the wound, he surrounds 
the sac with a loop, and passes it down to the ovary. In 
case the ovary resists the traction upon it, he ties and 
strangles the parts in the loop of the ligature. If the ovary 
is found to be hard he endeavors to extract it with the 
fingers; and if this cannot be done, he immediately puts 
on the ligature to cause its destruction. According to 
circumstances he tightens the ligature, and he says that 
what is best to be done to prevent accident is to amputate 
the ovary. If this can be accomplished without danger it 
should be attempted by all means. Once the sac is re- 
moved the only thing remaining is to close the wound." 

In the regular order of our study of the 
history in France of incisionism for the treat- 
ment of encysted dropsy of the ovary, we come 
to the consideration of another classic case re- 
ported under the title : " Observation sur un 
depot de la trompe, et sur l'extirpation de 
l'ovarie," par M. L'Aumonier, Chirurgien en 
chef du grand hopital a Rouen, et Corres- 
pondant de la Societe. 1 

The patient, Marie Louise Lagrange, aged twenty-one, 
entered the Hotel-Dieu, January 5, 1782, under the care 

1 Histoire de la Societe Royale de Medecine, 1782-83, p. 296. 



IN FRANCE. 325 

of M. L'Aumonier, feeble, emaciated, and having a low 
fever and diarrhoea, with general distension, tenderness and 
pain of the entire abdomen, together with a purulent 
vaginal discharge, following her confinement six or seven 
weeks previously. M. L'Aumonier, upon a careful exami- 
nation of her case, discovered a hard, round tumor in the 
hypogastric region, resisting and painful under pressure. 
Firm pressure upon this tumor was attended by a sudden 
purulent discharge from the vulva, of which he assured him- 
self positively by two or three similar investigations. By 
the touch he was able to determine that the external os 
uteri was in a normal state. 

L'Aumonier says : 

"The situation of the tumor, its connection 
with the matter in the uterus, the occurrence of 
an accouchement six or seven weeks previously, 
and the empty and flaccid state of the mammae, 
all pointed to a milk abscess (depot laiteux) 
situated in the ovary and Fallopian tube." 

"It was already late, and the strength of the patient 
seemed too feeble to attempt a decisive operation; but, 
according to the maxim melius anceps quam nullum, I de- 
termined to make an incision through the integument, 
muscles, and aponeuroses. It was made in the direction of 
the inferior plane of the external oblique muscle, com- 
mencing three fingers' breadth below the imaginary line 
between the umbilical and hypogastric regions. It was 
four inches in length, and made as carefully as possible in 
order to spare the subjacent parts. (Side not mentioned.) 

"The peritoneal cavity opened, I perceived a round 
tumor, of a bluish color, adherent below to the part of the 
peritoneum covering the inguinal ring, and free above, 
where it was surmounted, in the direction of the umbilicus, 



326 



MCDOWELL'S OPERATION 



by another oval-shaped tumor, the size of an egg, having a 
scirrhous solidity. The bluish part of the tumor was elas- 
tic, but fluctuation was distinct, and I could again, by 
compressing it, cause immediately to flow from the vulva 
a small quantity of pus. 

" Notwithstanding the size and considerable number of 
bloodvessels which ramified upon this tumor, I did not 
hesitate to plunge the bistoury into its cavity. In directing 
this incision from the part of the ovary having scirrhous 
hardness to the point where the Fallopian tube unites with 
the side of the uterus, the opening made gave issue to a 
pint at least of blackish pus of an odor the most infectious 
and penetrating I have ever smelled. 

"The pus being evacuated, I passed my finger as far as 
it would reach into the interior of this cavity, and in carry- 
ing the finger to the superior part of it I felt an excavation 
in the body of the ovary, the edges of which were of con- 
siderable hardness, and which obliged me to examine more 
carefully the part that I had previously regarded as scir- 
rhous. I tried to detach this part from the Fallopian tube, 
being sure now that the adherence was only the product of 
inflammation. Their separation was effected without dif- 
ficulty, and the point of adherence was found to be formed 
by the fixation of the fimbriated extremity of the Fallopian 
tube upon the body of the ovary, an occurrence which 
results from any stimulation whatsoever of the latter. The 
parts being separated, the ovary seemed to be sufficiently 
isolated, and could be seized without much difficulty for 
extirpation, it now being certain that the disorganization 
was irreparable. 

"The operation was simple, and included the applica- 
tion of a tenaculum to the upper part of the tumor (the 
hardened ovary), which fixed it, and facilitated the entire 
dissection without injury to the surrounding parts. 

" From a branch of the spermatic artery there was a little 
hemorrhage immediately after the extirpation, but it 
seemed to me of no great moment. A small bit of dry 



IN FRAXCE. « 2 y 

charpie, secured with a thread, as well as balls of the same, 
with which I filled the sac of the Fallopian tube, after hav- 
ing saturated them with the yellow of an egg, one-third 
honey, were all that was necessary for the internal treat- 
ment. Emollient embrocations to the abdomen, covered 
with lint, over all of which poultices were applied, con- 
stituted the external treatment." 

The morning after the operation the patient 
was very weak, answering questions only by 
"yes and no," but to use M. L'Aumonier's own 
words, " the purulent discharge from the vulva 
was absolutely dried up." 

On the third day he made the following ob- 
servations regarding the internal treatment of 
the abscess that was indicated : 

"I learned why the intestines do not present at the 
opening, as often happens in large incisions penetrating 
the abdomen. I readily discovered the causes of this — 
they are adhesions, resulting from inflammation between 
the circumference of the tumor and the peritoneum, which 
I have wished to overcome in order to avoid the pain they 
often occasion, from traction upon them, after the cure of 
the disease giving rise to them. I felt too great a resist- 
ance, and the patient too much pain, to push further the 
slight attempts that I made. I contented myself with 
treating the bottom of the ulcer with the small balls of 
charpie and the lint over the abdomen, medicated as pre- 
viously described." 

The progress of the improvement was unin- 
terrupted until the sixteenth day after the 
operation, when the patient was seized with 



3 28 MCDOWELL'S OPERATLON 

an hysterical convulsion which lasted several 
hours, though she appeared to come out of it 
all right. This was followed by the catamenia. 
On the second day of the flow the discharge 
from the wound was tinged with blood, the 
explanation of which M. L'Aumonier was not 
able to give — that is, as to whether it was men- 
strual or came from the sides of the granulating 
wound. He recognized, however, that the tinge 
gradually ceased with the menstrual flow. "At 
this stage the cavity of the Fallopian tube was 
reduced to about the size of an ^gg. ,f The 
wound completely cicatrized without any fistula 
remaining, and the patient was discharged 
cured, February 20, 1782. 

Mr. L'Aumonier concludes the report of his 
case in these words : 

" This example and that of total amputation of the uterus 
and vagina performed with success, justify the conclusion 
that, with a thorough knowledge of anatomy, there are but 
few organs upon which one' may not perform with advan- 
tage the different operations of surgery. " 

About twenty-five years after the report of 
L'Aumonier' s case was published (1 782-1807), 
the Inaugural Thesis of M. d'Ischier, at Mont- 
pellier, appeared in defence of the success of 
this operation as one of real extirpation of the 
ovary, coupled with the success of a similar 



IN FRANCE. 329 

operation in a case by M. Kapeler ; but, accord- 
ing to Velpeau, as has been shown, the efforts 
of the author failed to impress the profession 
with the importance he attached to these cases 
and their results. In this connection Velpeau 
does not even so much as quote the publication 
of L'Aumonier, or allude in the slightest way 
to any of the circumstances attending the 
operation he performed, thus leaving the 
reader wholly in doubt as to the source of 
M. d'Ischier's information upon the subject. 

This brings us to a still longer lapse (1807- 
1837) of almost total neglect, in France, of the 
treatment of ovarian dropsy, as the history of 
the subject would seem to prove. Notwith- 
standing the inauguration and recognized suc- 
cess by the McDowell procedure during this 
period in other countries, the first evidence we 
have of the revival of interest in the subject in 
France is found in the proposal of M. Mon- 
teggia. The evidence regarding Monteggia is 
based upon the high authority of Professor 
Malgaigne, 1 who regards his proposal as only 
a slight modification of that described in the 
report of a case by William Jeaffreson, Esq., of 

1 Manuel de Medecine Operatoire. Trans, by Dr. Frederick 
Bnttan, 1846. 



ooq MCDOWELL'S OPERATION 

England. The following is a description of 
Monteggia's proposal, as given by Professor 
Malgaigne : 

" This surgeon objects principally to the large incisions 
of the abdomen. He advises puncturing the tumor with a 
large trocar, and extracting the liquid ; and then, after 
having somewhat enlarged the opening, if necessary, intro- 
ducing long-branched forceps, like those of Hunter for 
the extraction of calculi from the urethra. By means of 
these forceps he forcibly seizes the sac, thus emptied, 
draws it outside, and then excises it near its base ; apply- 
ing to its pedicle a ligature, the two ends of which are 
brought out of the wound so as to be withdrawn when the 
remainder of the sac is completely detached and removed." 

In connection with the above proposal of 
Monteggia, M. Malgaigne describes the mode 
of treating encysted dropsy by incisionism asso- 
ciated with the name of Le Dran (i 736-1 746), 
and later with that of Galenzowski (1827) ; and 
of treating hernia of the ovary by excision, as 
coupled with the name of Deneux. He also 
describes the proposal of Theden for extirpa- 
tion of the ovary, and the actual operation of 
McDowell for the same purpose, but cites no 
instance in which either had ever been em- 
ployed in France. In the latter connection he 
says : 

"We find traces of this operation in divers authors; but 
the fi;st who framed an operative proceeding that he in-. 



AV FKAXCE. 



331 



tended adopting was Theden (between 1750 and 1760), 
and the first who performed it seems to have been Mc- 
Dowell (1809)." 

As to the further history of the treatment of 
ovarian dropsy in France, I must again refer 
to Professor Velpeau 1 as the best authority. 
For an explanation of the character of this 
treatment it is only necessary to state that an 
attempt was made in a case by M. Recamier to 
establish drainage with a seton through the 
vagina ; and in another case, by M. Marjolan, 
with an injection of honeyed barley water (eau 
d'orge meillee), both in the year 1839, and 
both terminated fatally. 

From all that has been said thus far upon 
the history of extirpation of the ovary for the 
cure of ovarian dropsy, in France, it appears 
that not a single operation up to this date was 
performed there according to the teachings of 
McDowell. As proof upon this point I would 
refer to the communication entitled " Quelques 
notes relatives a Pexcision des tumeurs ova- 
riques," Par Achille Chereau, D.M.P. 2 

This writer, in his remarks introductory to 
his Table of Statistics, speaks as follows : 

1 Op. cit. 

2 Journal des Connaissances Medico-Chirurgicales, 1844, t. i. 
p. 228. 



332 



MCDOWELL'S OPERATION 



"I will say at the outset that one need not expect to 
find in the following lines an apology for, nor a criticism 
upon, the operation forming the subject of this article. 
They are simply notes from extracts that I have read of 
the estimate of it in French publications, and from which 
it is my sole aim to briefly show the present state of the 
science relative to the excision of tumors of the ovaries. 
According to my knowledge, the attempts which have 
been made up to the present time to remove, in totality, 
tumors situated in the ovaries, amount to sixty-five, of 
which cases the appended Table shows the circumstances." 

The writer excludes from this Table the case 
of L'Aumonier, and assigns his reason for it in 
these words : 

"In that number I do not include the case reported by 
L'Aumonier, as has been done erroneously, in my opinion, 
by all the authors who have written upon this subject. If 
that surgeon did perform the ablation of one of the ovaries, 
it was performed in a fortuitous manner, as it were, and on 
account of the disorganization of that organ." 

Even at the date of the publication of this 
Table of Statistics, by M. Chereau (1844), two 
years after the revival of the operation of Mc- 
Dowell in England, he does not include a case 
operated upon in France by this procedure. 
Of the sixty-five cases given we find the follow- 
ing distribution of them, as to the countries in 
which these operations were performed : Great 
Britain, $& cases ; Germany, 1 7 cases ; United 
States, 9 cases ; anonymous, 1 case. 



IN FRANCE. 333 

Comments. — The points brought out in 
our study of the early history of ovarian 
dropsy in France show a wide range of in- 
vestigation with regard to the nature, origin, 
diagnosis, prognosis, and treatment of this 
disease by the incisionist ; and are of far 
greater interest than would seem from a 
cursory glance at the subject. Le Dran, as 
we have seen, during the few years (1736-46) 
that he devoted to the study and investigation 
of these several aspects of the subject, accom- 
plished much that was of real value toward 
advancing the prevailing knowledge at that 
period. The disease was then called scirrhus 
by all writers, and Le Dran so described it, 
believing the origin and seat of it to be inside 
of the sac, at or near its base, the attachment 
of the ovary to the uterus, or in one or both 
iliac fossae ; also, that the growth of the disease 
depended upon the gradual enlargement up- 
ward of a single cyst. The growth of the dis- 
ease he also knew to be confined at first to one 
side, and that as the growth gradually extended 
it occupied both sides, thus showing by these 
observations accuracy in differential diagnosis, 
and the importance he attached practically to 
being always able to determine the side on 



334 MCDOWELL'S OPERATION 

which the disease was seated. For the ordinary 
operation of tapping he was influenced by these 
considerations, and in the advance from this 
practice to that of incisionism he adhered even 
more strictly to the observance of the same 
general rule. 

From the known result in nearly, if not all, 
cases in which tapping was performed, he saw 
that the sac would refill sooner or later (in from 
a few weeks to several months), necessitating a 
repetition of the operation in order to relieve 
the distressed breathing and the embarrassed 
functions of the body generally, and by which 
alone death could be averted for a time. 

With this knowledge of the nature, seat, 
growth, and consequences of such tumors, he 
dared to make incisions below the umbilicus, by 
which the peritoneal cavity was laid open in its 
lower division ; to carry the finger or the hand, 
as the case might be, into the abdomen and 
pelvis in search of disease ; and to leave the 
cavity open for the employment of drainage 
and injections, by tent and tubes, as has been 
shown. In this way he actually cured, to all 
intents and purposes, one case that he operated 
upon, the patient remaining in a fair state of 
health, with only a fistulous opening, for four 



IN FRANCE. 335 

years ; and in another he completed the cure 
without a remaining fistula. In the first case he 
made a small incision in the right side, four 
inches in length, admitting about two fingers 
for exploration, using afterward drainage-tubes 
and injections ; but after six months, finding an 
increased growth of the tumor, he made across 
the lower part of the abdomen an incision six 
or seven inches in length, admitting the whole 
hand for exploration, and allowing of the same 
general after-treatment by tent, drainage-tube, 
and injections. In the second case he found 
the enlargement of two years' standing, occupy- 
ing both sides of the abdomen, and he tapped 
it. When the fluid was drawn off he discovered 
a scirrhous tumor, the size of a "melon," on the 
left side, and at the end of three weeks the 
abdominal distention was as great as ever ; 
whereupon, he decided to lay the abdomen and 
tumor open. This time he selected the linea 
alba below the umbilicus for his incision, ex- 
tending it to the pubes, with the intention, as he 
tells us, that the opening in the abdominal wall 
should not close up promptly, in order that the 
cyst itself might have time to contract, and the 
lower angle of the opening made in it be kept 
always near the angle of the external wound 



336 MCDOWELL'S OPERATION 

and the bottom of the sac, the scirrhous seat of 
the disease. In this way he was better enabled 
to employ his drainage-tube and injections to 
favor inflammation and suppuration of the walls 
of the cyst 

Le Dran's theory of the treatment employed 
in the above two cases was based upon former 
observations and experience, and his logical 
explanation of it, before he undertook the ope- 
rations in question, accorded most fully with the 
results which he achieved. 

The final result in the second case, as we 
have seen, was a complete triumph for the 
method of incisionism, without a remaining fis- 
tula. Had the tumor in the case not been a 
multilocular cyst, and complicated with adhe- 
sions, as was probably the case, Le Dran, with 
the incision he made, might have had a very 
different termination of the primary operation, 
to wit : the result of a spontaneous protrusion 
of the collapsed cyst through the abdominal 
opening, and a division by him of the pedicle, 
thus giving to the world an operation of com- 
plete extirpation of a dropsical ovary — the 
achievement left to McDowell just sixty-three 
years later (1809). 

Le Dran, although anticipated over a third of 
a century in the employment of incisionism by 



IX FRANCE. 237 

Houston, may properly be regarded as the first 
to fully comprehend and master the principle of 
the procedure, and thus to be able to secure its 
fullest fruition. For this the profession in his 
own country, and in all others as well, owe him 
more credit for the really scientific work he did, 
and for the triumph which he secured from it, 
than it is believed he has ever received. 

The four cases following Le Dran's are all 
of interest, as we have seen, illustrating, as they 
do, important points in regard to the origin and 
seat of encysted dropsies, and especially the 
first one (that of M. Mouton), in which the 
accumulation of fluid took place between the 
peritoneum and abdominal muscles, attaining 
enormous dimensions, and causing the death of 
the patient, while on her knees, the only posi- 
tion in which she had been able to breathe for 
two or three weeks previously. In another case 
(that of M. De La Chaud), the fluid forming the 
tumor was found between the folds of the peri- 
toneum. Next we have the case of M. Montau- 
lieu, in which the tumor was of a "cauliflower 
form," being, probably, of papillomatous origin ; 
and, lastly, that of M. Malaval, in which both 
ovaries were involved, and a correct diagnosis 
made, as was proved afterward by the autopsy. 



338 MCDOWELL'S OPERA Tl ON 

Next is the important case of M. Delaporte, 
from the peculiarities of which, as we have seen, 
he was led, after his attempt at removal by in- 
cision simply, to inquire, for the first time in 
the history of the treatment of ovarian dropsy: 
Would it not be possible il to remove the focus 
of the disease — namely, the tumor formed by 
the ovary?" 

In this instance Delaporte encountered a 
semi-solid tumor, no doubt multilocular in 
character, of enormous dimensions, and with 
no recognized features to indicate which ovary 
was involved. The greater prominence, how- 
ever, of the enlargement of the left side no 
doubt influenced him to make his incision here, 
and it was commenced just above the anterior 
superior spine of the ilium and extended up- 
ward and inward the length of five fingers' 
breadth. There is no evidence that Delaporte 
at any time introduced his finger or fingers 
through the opening for the purpose of explor- 
ing the interior of the tumor ; and the reason 
for this, no doubt, was that the gelatinous fluid 
it contained poured out in such continuous 
quantities that there was no opportunity to do 
it. He contented himself with simply looking 
on and noting the enormous discharge from 



IN FRANCE. 239 

day to day, until the eleventh, when the patient 
expired, the wound having given issue to sixty- 
seven pounds of fluid. At the autopsy Dela- 
porte found that the tumor involved the right 
ovary, instead of the left, where the incision was 
made — precisely the same obstacle to success 
by incision that Le Dran encountered in his 
first operation. The latter mistake in diagnosis, 
and consequently the error in puncturing the 
abdomen in the wrong place, was made by the 
physician previously in charge. This error of 
diagnosis and the unguided puncture on the 
right side gave rise, no doubt, in Le Dran's 
second operation in the same case, to the long 
transverse incision he was forced to make, ex- 
tending from the point of this puncture to the 
left side, the actual seat of the tumor. Had 
the diagnosis of the seat of the disease been 
correct in Delaporte's case, and the incision 
made into the tumor on the right side, instead 
of the left, near its base, the probability is that 
all of the fluid would have escaped in a far 
shorter time. Thus would the chances of saving 
the life of his patient have been increased to a 
certain extent ; and by enlarging his incision to 
admit the hand into the interior of the tumor 
for breaking up the partitions between the 



340 MCDOWELL'S 0PERATL0N 

minor cysts, as Le Dran did for diagnostic pur- 
poses in his second operation, he would have 
increased his chances still more, probably to 
the extent of removing the entire diseased mass 
at the time of his operation. But, after all, it 
was no doubt his error of diagnosis as to the 
ovary involved, and the great disadvantage ex- 
perienced from making the incision so far from 
the base of the tumor, that led Delaporte after- 
ward to institute the inquiry he did as to the 
preferableness of the incision being made over 
the focus of the disease, and of the removal of 
the affected organ in totality. 

Of the originality of the proposal of Dela- 
porte there seems to be no question. Certainly 
there is no evidence accessible to show that he 
was acquainted with the Eastern custom of re- 
moving normal ovaries in women mentioned 
by Lisfranc ; or that he was influenced by the 
well-known expedient of removing the ovaries 
in the female of quadrupeds which has come 
down to us from former centuries ; nor is there 
any reason to believe that he was at all familiar 
with the discussions upon the same subject by 
Schlenker, Willius, Peyer, and Targioni, claimed 
by Velpeau to have taken place during the 
thirty years previously (i 722-1 750). 



IN FRANCE. 24I 

Delaporte makes no mention of the work of 
Le Dran, as appears from the history of his 
case and operation ; but no one can fail to see 
that he was a strict follower of the latter as 
regards the procedure of incisionism. 

A fact deserving emphasis in this connection 
is that the four incisions made in the three 
cases of Le Dran and Delaporte, distinctive of 
the old method of incisionism, were restricted 
to the lower division of the abdomen alone (a 
line extending across the longitudinal axis of 
the body, at the umbilicus, being the limit), and 
were of variable length. These incisions for 
convenience in description may be divided into 
the short and the medium. One of them on 
the right side was four inches long ; one of them 
on the left was made four inches at first, and 
then extended somewhat into the medium, one 
reaching from four to six inches in the linea 
alba up to the umbilicus, and another medium 
or long, reaching transversely from the right to 
the left side and six or seven inches in extent. 
These incisions, all in the lower division of the 
abdomen, as stated, and made without refer- 
ence to the axis of the body, except in one in- 
stance, constitute the most important feature 
of the old method of incisionism. The one of 



242 MCDOWELL'S OPERATLON 

Le Dran, however, which extended transversely 
across the body, without regard to the direction 
of muscles or the course of large bloodvessels, 
was made in a most unjustifiable way. 

Theden's scheme of extirpating a dropsical 
ovary, an extension of incisionism, was unques- 
tionably the outcome of Delaporte's proposal. 
It was characterized by a short incision four 
inches long in the inguinal region, as he sup- 
posed the diseased ovary to be outside the 
peritoneum. After exposing the organ and 
giving vent to the contained fluid he would 
draw the cyst out, put a ligature on its point of 
attachment, and cut it away. The tumor on 
being found hard, and not susceptible of being 
drawn out and excised, was to be seized with 
the fingers and forcibly brought out. Suffice 
it to say that this was merely a theory as to 
what the author thought an operation ought to 
be for the purpose indicated. It is, however, 
of interest here to refer to it, for the reason 
that it excited no little attention in France at 
the time of its proposal, was extolled by Mo- 
rand, and by two English surgeons, Power and 
Darwin, and was even favorably commented 
upon by Malgaigne, as late as 1842, as the 
first scheme proposed for extirpation of the 



IN FRANCE. 343 

ovary, while McDowell's procedure was the 
completion of it. 

L'Aumonier performed his operation from 
twenty to thirty years (1782) after the proposal 
of extirpation of the ovary by Delaporte, and 
the plan of executing- it as formulated by The- 
den. L'Aumonier's operation forms an im- 
portant era in the history of incisionism in 
France, as we have seen, and requires more 
than a passing notice. It was performed upon 
a young woman, aged twenty-one, six or seven 
weeks after an attack of puerperal peritonitis, 
resulting as the facts show, in a pelvic abscess 
which opened from Douglas's pouch into the 
vagina, the most favorable of the four common 
outlets of such purulent accumulations. L'Au- 
monier, finding a tumor of considerable hard- 
ness in the hypogastric region, and perceiving 
that pressure upon this region caused sudden 
and repeated gushes of matter from the vulva, 
concluded erroneously that an abscess of the 
ovary existed, which had opened into the cor- 
responding Fallopian tube, whence the pus 
escaped through the uterus and vagina. The 
external uterine orifice, he averred, from a digi- 
tal examination, to be in a normal state. His 
operation, based upon this theory of the 



o 4 4 MCDOWELL'S OPERATION 

enlargement he found in the hypogastric re- 
gion, consisted, as we have seen, in making an 
incision over the prominent part of the dis- 
tended region (tumor) four inches in length, 
running obliquely across the linea alba, the side 
of the affected ovary not being mentioned. 
The bluish fluctuating tumor found at the bot- 
tom of his incision, after dilatation with the 
fingers, he says, was attached below, over the 
inguinal ring of the affected side, and floating 
above, while it was surmounted by another little 
tumor the size of an Qgg, having a hard feeling 
(Jwneur skirrheuse). Below this latter point 
he plunged his bistoury (this being the second 
step of the procedure), extending the division 
of the structures down to the angle formed by 
the Fallopian tube of the corresponding side 
with the uterus, and thus gave vent to a pint 
of blackish and most offensive purulent fluid. 
His next step was the introduction of his finger, 
to its full length, into the wound, and this re- 
sulted in the discovery, as he says, in the upper 
side of the cavity of "an excavation in the body 
of the ovary of which the borders were of con- 
siderable hardness," corresponding in situation 
almost precisely with the hard-feeling little 
tumor surmounting the bluish tumor, as de- 



IN FRANCE. 345 

scribed. The small opening through which his 
finger passed to reach this point led him to 
reconsider his first opinion regarding this hard- 
feelinQf little tumor. The result was, he dis- 
covered, as he states, that the small opening 
mentioned, with "hardened borders," was the 
outlet of an abscess in the ovary, and that the 
" organ was disorganized beyond reparation. 
But in this reinvestigation of the parts involved 
he overlooked the fact that the fluctuating little 
bluish tumor, fixed below, floating above, and 
surmounted by the hard-feeling little tumor, 
still remained unexplained. The seizing of the 
disorganized ovary, with "hardened borders," 
with a tenaculum, the removal of it entire by 
dissection without injury to the surrounding 
parts, and with a loss of only a few drops of 
blood, all tend to prove the operation to have 
been not only complex and unique, but of a 
character bordering on the marvellous. Such 
a procedure, without any explanation of the 
character of the specimen so removed, cannot, 
however, be accepted as justifying the import- 
ance given to it by L'Aumonier, to say nothing 
of the inconsistency of his statements regarding 
the anatomical and pathological structures in- 
volved, and their relations one with another. 



346 MCDOWELL'S OPERATLON 

The claim, therefore, of an abscess of the ovary 
emptying into the corresponding Fallopian 
tube, and of the extirpation of the diseased 
organ, it must be said, is not only opposed by 
the vague pathological description of the struct- 
ures implicated, but by sound principles of 
surgery. 

It is clear enough, from what we have read of 
L'Aumonier's description, and the analysis here 
made of the different steps of his operation, 
that the true explanation is that given in the 
outset, viz. : that the enlargement found in the 
hypogastric region was nothing more or less 
than a pelvic abscess in Douglas's space, result- 
ing from puerperal peritonitis, with rupture of 
the pouch, and discharge through the vagina. 

The proof of the above explanation is, on the 
one hand, the impossibility of L'Aumonier's 
forcing out in sudden and repeated gushes a 
purulent fluid through the Fallopian tube, the 
uterus, and its external orifice, in a normal state, 
as he describes ; and, on the other hand, of the 
entire practicability of his being able to do this 
easily by the same manipulation with the open- 
ing that existed between the bottom of Dou- 
glas's pouch and the vagina. Besides, the 
extirpation of the hard-feeling little tumor sur- 



IN FRANCE. 347 

mounting the large bluish tumor actually con- 
taining the purulent fluid, without reference to 
the walls of the tumor, would have been impos- 
sible, as described, and his claim of successful 
removal of a disorganized ovary is therefore 
clearly absurd. 

As another proof of the absurdity of L'Au- 
monier's having even discovered, to say nothing 
of his removing, a disorganized ovary indepen- 
dent of the walls of the sac containing the pus, 
it is only necessary to assume (which is in strict 
accordance with his description) that the upper 
part of the large cavity was bounded by the 
broad ligament and the fundus of the uterus, 
the latter being drawn over to the affected side 
by adhesions. This being understood, it is 
easy to see that the hardened substance finally 
recognized in the sac, claimed by him to have 
been seized with the tenaculum and removed, 
was not the disorganized ovary at all, but the 
fundus of the uterus. Whether he dissected 
out this "without injury to the surrounding 
parts" remains, in my opinion, an open question. 

From this it follows that the small opening 
admitting L'Aumonier's finger was nothing 
more or less than the point of communication 
between two parts of the large bluish tumor 



348 MCDOWELL'S OPERATION' 

actually containing the pus, one being on the 
affected side of the uterus, and the other in 
Douglas's pouch ; and that when he passed his 
finger through the small opening into the cavity 
of the ovary, as he supposed, he simply passed 
it under the fundus of the uterus into Douglas's 
pouch, thus showing the continuity of the two 
portions of this cavity, viz. : the bluish-looking 
tumor, or pus sac, which he had cut down upon 
in the outset of his operation and punctured. 
By so doing he gave vent to the pint of con- 
tained pus, and caused the "drying up" the 
day afterward of the purulent vaginal discharge, 
as he describes. 

In justice to L'Aumonier, however, it is 
proper to state that the incision made by him 
for the relief and cure of his case of pelvic 
abscess was simply an extension of the principle 
of incisionism as employed by Houston and 
Le Dran, especially in the first case of the lat- 
ter, nearly fifty years previously. In the result 
thus achieved by him of completely emptying- 
Douglas's pouch by the procedure described, 
and thus curing his patient, is to be found his 
triumph, which was truly brilliant for his day, 
and would even do credit to the most advanced 
laparotomist of the present time. 



IN FRANCE. 3 4 g 

In this connection it is also proper to state 
that in the various references made by subse- 
quent writers to L'Aumonier's case there has 
been an extraordinary reticence, and conse- 
quently a misunderstanding regarding its diag- 
nosis, and the precise character of the operation 
he performed. Hence the non-appreciation of 
the operation as to its true merits, not as a 
procedure of extirpation of the ovary, so erro- 
neously claimed for him, but as a practical 
extension of the procedure of incisionism to the 
relief and cure of pelvic abscesses, and a de- 
monstration of its availability in other serious 
conditions, such as tubal pregnancy, pyosal- 
pinx, etc., to the value of which the attention 
of the profession has only been pointedly 
directed within the last decade. 

Again, as we have seen, twenty-five years 
after the publication of L'Aumonier's case, the 
claim of successful extirpation of the ovary by 
the latter was revived, in the Inaugural Thesis 
of M. d'Ischier, in connection with the success 
of Kapeler's case, and the fact that the date of 
this thesis was only two years before that of 
McDowell's first operation also proved preju- 
dicial to the recognition of McDowell's claims, 
from the constant references made to the sub- 



^O MCDOWELL'S OPERATION 

ject at that time, and the want of knowledge of 
the real facts of the case — M. d'Ischier, instead 
of L'Aumonier, being usually referred to by 
authors. This was done even by Velpeau 
himself. 

Of all the French writers that have been con- 
sulted in connection with this subject only one 
has been found (M. Chereau) who quotes 
directly from the publication of L'Aumonier s 
case, as recorded in the Histoire de la Societe 
Roy ale de M&decine, L/82-Sj. 

In concluding these comments, I would state 
state that during all these years of the history 
of McDowell's operation (the period of our 
present study of the subject, 1809-42), not a 
single report of an operation according to this 
procedure has been found in the medical litera- 
ture of France. The question may well be 
asked: What was the cause of this seeming 
neglect of the procedure ? Could it have been 
from dissatisfaction with the character and 
results of the few operations performed during 
the period of the old procedure by incisionism ; 
or did it result from the failure of surgeons, for 
all these years, to regain sufficient confidence 
to make the trial of a different and more pro- 
mising operation ? 



IN GERMANY. ^ 

SECTION III. 

Germany. 

A great deal has been said of Professor 
Dzondi, of Halle, and the association of his 
name with ovariotomy. In the United States 
Dr. Nathan Smith, in the report of his success- 
ful case of ovariotomy (1822), refers to Dzondi's 
practice of incision and drainage ; and, evidently 
impressed with the importance of his views 
upon the subject, disclaims any knowledge of 
them prior to the date of his operation. Dr. 
W. L. Atlee places his name in his "Table of 
Statistics" (1851), before that of McDowell as a 
successful ovariotomist. In England Mr. John 
Lizars, in his paper entitled " Observations on 
the Extirpation of the Ovaria, with Cases," 
published in 1824, speaks of Dzondi's successful 
treatment of dropsical ovaries. Velpeau, at a 
still later date, mentions the plan of treatment 
ascribed to Dzondi by Mr. Lizars, but calls 
attention to the contradictory statement upon 
the subject by Dr. Dolhoff, of Magdeburg, 
Prussia, a pupil of Dzondi. 

As to the real facts relating to the credit 
attributed to Dzondi in the United States and 



352 MCDOWELL'S OPERATION 

in England, as above shown, a reference to his 
published work, entitled : Beitraege zur Ver- 
volkommung der Heilkunde (1816), an Eng- 
lish review 1 of which I have consulted, shows 
that the practice attributed to Dzondi did not 
relate to the treatment of dropsical ovaries at 
all, but to that of encysted dropsy ("hydrops 
succatus peritonei ") in the case of a boy, 
Christopher Shultz, twelve years of age. The 
operation he performed was simply a puncture 
with a trocar of the distended abdomen, which 
was made in the presence of Dr. Funke, May 
24, 18 1 4. After the fluid was drawn off he en- 
larged the trocar puncture by incision, and 
" introduced into the orifice a large linen tent 
dipped in oil, and secured it externally by ad- 
hesive plaster." The tent was removed every 
other day, the size being gradually increased 
until the twenty-sixth day after the operation, 
when a ragged point of the cyst wall showed 
itself at the fistulous orifice, and was seized with 
a pair of forceps and entirely drawn out, piece 
by piece. The patient recovered. 

The reviewer of Professor Dzondi's work 
says of the principle of the treatment employed 
in the above case, that it "might be resorted to 

1 Am. Med. Recorder, 1820, vol. iii., p. 57. 



IX GERMANY. 353 

with equal success in ovarian dropsy, as soon 
as the sack lies between the peritoneum and 
the external covering (muscular wall), as is 
generally the case, and if the ovary itself has 
not yet entered into an ulcerated and scirrhous 
state." This theory of the ovaries being out- 
side of the peritoneum will be recognized as the 
same taught by Theden in France, 1 750-1 760. 

Thus is made clear what was actually pro- 
posed and accomplished by Dzondi in a case of 
encysted dropsy in a boy ; but it is also evident, 
from the presentation of the subject of incision- 
ism in France, where it was practised nearly 
three-quarters of a century earlier, that Dzondi 
had profited from the teachings of the incision- 
ists there, and, consequently, was entitled to 
no claim of originality of the employment of the 
principle further than as regards its extension 
by applying it to the successful treatment of 
encysted dropsy other than ovarian. 

Let us next see with what success McDow- 
ell's operation of ovariotomy by his long inci- 
sion was first employed by German surgeons, 
from the results as set forth in the recorded 
cases of Chrysmar, Martini, Dieffenbach, Ehr- 
hartstein, Quittenbaum, Dolhoff, Groth, Chriss- 
man, Ritter and Stilling. 
23 



354 MCDOWELL'S OPERATION 

To Dr. Chrysmar, of Isny, in Wurtemberg, 
is justly due the credit of having been the first 
in Europe to perform McDowell's operation, 
although he is credited by Dr. Hopfer, of Biber- 
bach, with having been the first anywhere to 
perform extirpation of a dropsical ovary, since 
no mention is made by him of the American 
operation. The facts are, that Chrysmar's first 
case, reported by Dr. Hopfer, bears the date of 
May 1 6, 1819 — nearly ten years after McDow- 
ell's first operation, and more than two years 
after the publication of his first three cases 
(181 7). Beside this, Chrysmar's first recorded 
cases bear the ear-marks of the long peritoneal 
incision, the full exposure of the peritoneal 
cavity, and the bringing out in the lower angle 
of the wound the ends of the ligature on the 
pedicle, which are themselves enough to prove 
beyond the shadow of a doubt the priority of 
the American operation, independent of Dr. 
Hopfer's statements, dates, or publications. 
Dr. Hopfer, in his report of Chrysmar's three 
cases, entitled : " On Extirpation of Diseased 
Ovaria," 1 states the circumstances under which 
he became acquainted with Dr. Chrysmar and 

1 Monthly Journ. of Foreign Med., 1829, vol iii., p. 440; trans- 
lated from Medicinische-chirurgische Zeitung, Feb., 1827. 



IN GERMANY. 



355 



the results of his operations. In 1 819, as Medi- 
cal Superintendent, he went to Allgiiu, in the 
district of Swabia, where Chrysmar enjoyed a 
wide reputation, and had already, as he learned, 
performed two operations, one of which was 
successful. Hopfer says that during his three 
years' residence in Swabia Dr. Chrysmar per- 
formed three operations for extirpation of dis- 
eased ovaria, two of which he witnessed, and 
the third of which was a case of his own 
(Hopfer's). 

Case I. — Mrs. Leupalz, aged forty-seven, presented her- 
self to Dr. Chrysmar with, a hard tumor in her left side, 
about the size of a child's head, complicated with ascites. 
The operation was performed May 16, 1819. The long 
incision of McDowell was adopted, extending in the linea 
alba from the ensiform cartilage to the pubes, with full 
exposure of the abdominal cavity. Extensive adhesions 
were found between the tumor and the arch of the de- 
scending and transverse colon, as well as the great arch of 
the stomach. The ligature was brought out at the lower 
angle of the wound. Patient expired thirty-six hours after 
the operation. The diseased ovarium weighed seven and 
a half pounds. Its surface was irregular and knotty, and 
upon section its structure was of a cartilaginous and fibrous 
character, with small "intervening cavities, filled with 
greenish offensive sanies." 

Case II. — A. B., aged forty, presented herself with a 
tumor, the size of a child's head, in the left side, with dis- 
tinct fluctuation, and anasarca of the lower extremities. 
In June, 1820, Dr. Chrysmar performed the operation in 
the presence of Dr. Bawnwarth and three other surgeons. 
The long incision was employed, as in the preceding case, 



356 



MCDOWELL'S OPERATLON 



with full exposure of the abdominal cavity. No adhesions. 
Wound closed with sutures, and the ends of the ligature on 
the pedicle brought out at the lower angle of the wound. 
The tumor weighed eight pounds. Patient returned home 
well at the end of six weeks. 

Case III. — A single woman, of Bavaria, named Schei- 
deck, aged thirty-eight, with abdominal tumor, spinal 
curvature, and deformed pelvis, applied to Dr. Hopfer in 
1820 for treatment, but he advised her to consult Dr. 
Chrysmar. The latter decided to make the operation for 
removal of the tumor, which he did in the presence of Dr. 
Hopfer and three assistants. The long incision was made, 
with full exposure of the abdominal cavity. There were 
slight adhesions, but the pedicle was found to be short and 
four inches thick. It was tied with a double ligature, 
wound closed with sutures, and ligature brought out at the 
lower angle of the wound. Death, preceded by convul- 
sions, took place at the end of thirty-six hours. " Tumor 
weighed six pounds and a half, and, on being divided, pre- 
sented a lardacious texture, with numerous fibrous cysts, 
filled with a brownish stuff, like size." 

Next follow two cases operated upon, respec- 
tively, by Dr. E. Martini and Prof. Dieffenbach. 

Case IV. — Woman, aged twenty-four, with enlarge- 
ment of her left side, believed by her former physician to 
be due to an ovarian tumor, consulted Dr. Martini in 
April, 1827. She had previously been tapped four times, 
the last time only a month before her admission, at which 
date the cavity of the cyst was injected with water and 
alcohol in the proportion of 8 : 1. Dr. Martini, at a fifth 
tapping, made two punctures at the same sitting to relieve 
distention ; after which he decided to make an incision in 
the linea alba three inches below the umbilicus. This 
incision was then enlarged above and below to the extent 
of nine inches (McDowell's incision). The tumor was the 



IN GERMANY. 0-7 

size of a man's head, round, smooth, and of a " cartilagi- 
nous consistence," and it seemed solidly fixed in the brim 
of the pelvis. He could not find the pedicle. In the 
upper part of the tumor there was a large cyst which was 
punctured and evacuated, the canula being left in it to 
insure drainage. Wound closed with sutures, the canula 
projecting from the line of union. Case terminated 
fatally seventy-two hours after the operation. Disease 
was found seated in the left ovary, as diagnosticated. 

Case V. — A Polish woman, aged forty, after having 
been examined by a number of surgeons, finally consulted 
Prof. Dieffenbach in regard to a large tumor in the abdo- 
men, which she believed resulted from a blow received ten 
or twelve years previously. Prof. Dieffenbach decided to 
operate, and made the long incision, extending along the 
linea alba to the pubes (McDowell's incision). The 
lower part of the tumor, and its relations to the uterus 
and bladder could not be made out — it having a 
broad base and seeming to be attached to the vertebral 
column. It was somewhat round, of a bluish color, and 
of almost cartilaginous hardness, and contained large 
bloodvessels. The puncture in the tumor was followed by 
profuse bleeding, which could be controlled only by com- 
pression. It was deemed proper not to attempt a removal 
of the tumor. Wound closed by sutures. Patient re- 
covered. 1 

The following is a short abstract of a case 

reported by Dr. Ehrhartstein, 2 translated from 

the Med. Jahr. des Oester Staats : 

Case VI. — Mrs. A. D., aged thirty-one, in her fifth 
pregnancy showed enormous abdominal distention, which 
was but little diminished after her delivery. The cause of 
this was soon after discovered to be enlargement of the 

1 Archives Generales de Medecine, 1829, t. 20. 
3 Medico-Chirurg. Rev., July, 1833, vol. xix. 



358 



MCDOWELL'S OPERATION 



right ovary ; the case thus illustrating the possibility of 
such tumors becoming complicated with pregnancy. The 
cyst was partially relieved by puncture with the trocar 
and the abstraction of fourteen pounds of fluid ; where- 
upon another similar cyst w r as discovered, and a second 
puncture made, giving vent to twelve pounds more of 
fluid ; thus proving the tumor to be multilocular. The 
operation was performed eighteen weeks after delivery. 
The length of the incision is not stated, but presumably 
the long incision was employed, from the facility with 
which the existing adhesions were overcome and the opera- 
tion completed — only fifteen minutes being required for 
the purpose. Ligatures were applied to three bleeding 
vessels, but special treatment of the pedicle is not men- 
tioned. It is to be inferred, however, that the ligatures 
were brought out at the lower angle of the wound, since it 
is stated that the threatening febrile symptoms intervened, 
which were only relieved on the eighth day by a discharge 
from the wound, "of bloody serum and gas." The 
emptied tumor weighed twelve pounds, and was found to 
be composed of numerous cavities. The patient was dis- 
charged cured at the end of nine weeks. 

Case VII. — All the details of the case of Dr. Quitten- 
baum, next in order, are not accessible, but the writer has 
been able to ascertain that he performed the operation 
November 18, 1834, and that his incision was four inches 
in length. The cyst was successfully removed, and the 
patient made a complete recovery. 

Dr. DolhofT, 1 of Magdeburg, Prussia, in a 
communication entitled "On the Puncture and 
Extirpation of Tumefied Ovaries," makes two 
divisions of ovarian cysts, requiring two differ- 

1 L' Experience, 1837-38, t. i. p. 625; from Rust's Magazin, 
1838, 1st series, vol. li. 



IN GERMANY. 359 

ent plans of treatment, viz. : first, unilocular 
cyst, with puncture by trocar, incision, tent and 
injections (incisionism) ; and, second, multiloc- 
ular cyst, with incision and extirpation. He 
encountered two cases of the first variety, 
which w r ere treated by incisionism with injec- 
tions of red wine, a weak solution of nitrate of 
mercury, etc., and both of which terminated 
fatally (1829-33). Of the second variety 
(multilocular) he relates three cases. In the 
outset he speaks of the difficulty of diagnosis 
and the justifiability of the operation in this 
class of cases. He refers to Prof. Dieffen- 
bach's case, 1 in which there was a mistake in 
the diagnosis, and, consequently, failure to 
remove the existing tumor. In two of Dol- 
hoff's cases the tumor was removed, and in the 
third no tumor was found. 

Case VIII. — Maria Bock, aged twenty-three, after an 
attack of tertian intermittent fever, in 1832, first noticed a 
swelling in the left side. Little by little this tumor in- 
creased in size until the spring of 1833, when, after receiv- 
ing various opinions upon her case, she applied to Dr. 
DolhofT, and was admitted to the hospital at Magdeberg. 
The girth of the abdomen was then fifty- three inches, and 
the condition was attended by great embarrassment in 
breathing. The tumor was irregular, and hard under 
pressure, fluctuation being very obscure. Dr. DolhofT 
called for a consultation with his colleagues upon the case, 

1 Rust's Magazin, vol. xxv. 



360 



MC D WEL L ' 6" OPERA TION 



and there was great diversity of opinion as to the true 
character of the tumor. He himself believed the disease 
to be ovarian. It was agreed by all that the tumor should 
be punctured, as it was thought that this would throw more 
light upon the diagnosis. Dr. Dolhoff found, however, 
that the abdominal was so thick everywhere, except in the 
lower part, where there was risk of wounding the bladder 
from puncture with a trocar, that he decided to first make 
an incision into the peritoneal cavity, and then puncture 
the cyst. The point of election was to the left of the 
umbilicus, where the surface was more elevated than else- 
where, and here a perpendicular incision, two inches in 
length, was made through the muscular wall. (Sept. 27, 
1833.) After a considerable quantity of ascitic fluid had 
escaped through the wound a puncture was made in the 
tumor, but only a little dark, thick fluid escaped ; where- 
upon the abdominal wound was enlarged, and an incision 
made into the cyst wall, found to be about an inch thick, 
and the contained fluid, of a gelatinous character, evacu- 
ated. The hand was next introduced, and the contents 
broken up and removed as far as possible. A large portion 
of the posterior cyst wall (about the size of a man's hand) 
was seized with forceps, drawn out, and cut off. It still 
being found that the tumor could not be removed from the 
abdominal cavity, the external incision was enlarged to the 
extent of seven or eight inches (McDowell's long incision), 
when the diseased mass became more movable, and was 
readily lifted out through the wound, there being no adhe- 
sions. The pedicle was found to be the size of the little 
finger, and was included in a strong ligature. After cut- 
ting away the tumor Dr. Dolhoff discovered the orifices of 
two arteries in the end of the divided pedicle, about the 
size of a crow's quill, and, fearing that his ligature might 
slip off, he tied each artery separately, and removed the 
ligature, including the pedicle in mass, thus guarding more 
effectually, as he believed, against secondary hemorrhage. 
He does not so state, but it is to be inferred, that he cut the 



IN GERMANY. 



361 



ligatures off close to the knots, as the irritation likely to 
result from the ends of the ligatures would be an additional 
reason for his change in the mode of treating the pedicle. 
The wound was closed with sutures, and the patient died 
sixty hours after the operation from extensive peritonitis, 
as was found at the autopsy ; though the symptoms up to 
the time of death did not indicate this lesion, a circum- 
stance thought to be very extraordinary by Dr. Dolhoff 
and his colleagues. The tumor and its contents weighed 
forty six and one-half pounds. 

Case IX. — Emilie Rcettcher, aged twenty-seven, ad- 
mitted to the hospital at Magdeburg, September 28, 1833, 
with a tumor in the left side of the abdomen, felt by the 
patient to be movable from side to side, and believed by 
her to have resulted from a blow. Dr. Dolhoff made an 
examination, and found the tumor to be a little larger than 
a child's head, of globular form, and pushed toward the 
right side. Operation October 21, 1833. A medium 
incision was made in the linea alba, from the umbilicus to 
the pubes, but this being found too small, it was extended 
two inches above the former. (McDowell's long incision.) 
This brought to view a hard tumor, covered above by the 
omentum, and containing bloodvessels enormously en- 
larged, and numerous little growths of a whitish and bluish- 
red color, while below it was solidly fixed in the pelvis, 
rendering introduction of the hand impossible. From the 
condition thus revealed an attempt at removal was deemed 
unjustifiable, and the wound was closed in the usual way 
with sutures, etc. The patient died eight hours afterward. 
At the autopsy the tumor was found to fill the pelvis, and 
to be firmly united by adhesions to the pelvis, uterus, 
bladder, rectum, and both ovaries, and it was not possible 
to determine in which of these organs the growth had 
originated. 

Dr. Dolhoff, in commenting upon the above 

case, says that, although the growth of the 



362 MCDOWELL'S OPERATLON 

tumor was of short duration, and the sensation 
of the tumor, as described by the patient, was 
as if it fell from side to side, the diagnosis as 
regards its mobility proved to be wholly faulty, 
and the removal of the tumor practically 
impossible. 

In the introduction to his third case of peri- 
toneal section Dr. Dolhoff, in a most commend- 
able way, states that it illustrates a grave error 
in diagnosis, and the unjustifiability of the ope- 
ration he performed. He says he delayed for 
some time before reporting the case, thinking 
it would be ridiculed. But, conscientiously 
believing it to be the duty of every surgeon to 
report his mistakes as well as his triumphs, he 
could not in this instance depart from the rule, 
consoling himself with the knowledge that he 
was not alone in the world in his particular, 
since a celebrated surgeon had already pub- 
lished a similar experience. (His reference 
here being to the unfortunate case, in Great 
Britain, of Mr. John Lizars.) 

Case X. — Friederike Gollner, aged twenty-three, un- 
married, after an obstinate attack of tertian intermittent 
fever in 1835, of which she was cured by large doses of 
quinine, suffered from retention of urine (with varying 
quantities of mucous and purulent deposits in the urine 
drawn off), requiring the use of the catheter three or four 



IN GERMANY. 



363 



times a day. There was also obstinate constipation of the 
bowels, for the relief of which, at times, three drops of 
croton oil would be used. Following this condition of 
things the patient, after several months, began to have 
tenderness in the lower part of the abdomen. This ten- 
derness was soon succeeded by distention of the abdomen, 
gradually extending itself to and above the umbilicus, 
which would alternately become more or less effaced and 
then salient. With the increase of the vesical trouble and 
the abdominal tenderness and distention, a hard rounded 
body, seemingly the size of a foetus, was discovered occu- 
pying principally the epigastric region. Dr. Dolhoff, after 
consultation with his colleagues, all of whom agreed that 
the enlargement was due to the presence of ovarian disease, 
decided to remove the tumor. He performed the opera- 
tion September 29, 1836, making a medium incision in the 
linea alba, from the umbilicus to the pubes. On intro- 
ducing his hand into the abdomen and carefully searching, 
however, he could not, to his own astonishment and that 
of his colleagues, discover any tumor. The wound was 
closed with sutures in the usual way, and the patient made 
a speedy recovery. 

In commenting- upon the result of his first 
case, Dr. Dolhoff congratulates himself upon 
applying his ligatures separately to the two 
arteries found in the pedicle, thus guarding his 
patient against the additional danger of hemor- 
rhage by the ligature slipping off the pedicle. 
He calls the attention of the profession to this 
method of treating the pedicle, and in this con- 
nection refers to the history of an operation 
performed by Dr. Groth, whose name appears 



3 6 4 



MCD O WELL'S OPERA TIOX 



in several of the statistical tables published, 
though without comments. 

Case XI. — A woman named Waswo, of Schonmoor, 
consulted Dr. Groth in regard to an enlargement on the 
left side of the abdomen, which he attributed to a dropsical 
condition of the left ovary. He recommended the extir- 
pation of the diseased organ, and to this the patient readily 
consented. The operation was performed in 1833, but the 
kind of incision is not mentioned in the account of his 
operation, though it is believed to have been the long. 
The pedicle was encircled with a ligature in the usual way, 
and the tumor removed. The patient died six hours after 
the operation from secondary hemorrhage, which is be- 
lieved by Dr. Dolhoff to have been caused by the slipping 
of the ligature from the pedicle. 

Case XII. — Of the case of Dr. Ritter (1839), which is 
referred to by statistical writers, the details are not accessi- 
ble, and all that is known in regard to it is that he em- 
ployed the long McDowell incision, and successfully 
removed a fluid cyst, with no adhesions, and weighing 
twelve pounds. 

Case XIII. — This is Dr. Stilling' s case, 1 and here again 
there is a lack of details. We learn, however, from the 
Statistical Table of Mr. Phillips, that an incision (medium) 
was made six inches in length, that no adhesions were 
found, and that the patient died from hemorrhage. 

Case XIV. — The case of Dr. Chrissman is included in 
the Tabular Statement of Mr. Benjamin Phillips (r844), 
but the date of his operation is not given, though it is 
placed, chronologically, before that of Mr. Jeaffreson 
(1836), in England. Of the character of his operation it 
may be stated that he employed McDowell's long incision, 
found no adhesions, removed a tumor weighing twenty-two 
and a half pounds, and cured his patient. 

1 Holcher's Hanoversche Annalen, 1841. rift. 3. 



IN GERMANY. 365 

Summary of cases and results in Germany, 
including the two of Dr. Chrysmar referred to 
by Dr. Hopfer, but not reported : 12 completed 
operations with 5 cures and 7 deaths ; 3 unfin- 
ished operations with 1 recovery and 2 deaths ; 
1 unjustified operation with recovery. Mortal- 
ity of complete operations 58.33 per cent. 

Comments. — This completes the history, as 
far as it can be ascertained, of McDowell's 
operation in Germany as regards its initiatory 
trial in sixteen cases (1819-1841). Two cases 
of Dr. Chrysmar, in addition to his three re- 
ported cases, are included in my summary upon 
the authority of Dr. Hopfer, who states that 
one of them was cured and one terminated 
fatally, making in all for Dr. Chrysmar five 
cases, with two successes and three deaths. It 
is proper to mention that McDowell's work is 
not alluded to in connection with a single one 
of these sixteen cases, so far as I have been 
able to learn, and that the only way by which I 
have been enabled to trace the influence of his 
teachings upon the surgeons performing these 
operations has been through careful study of 
his long incision, and the extension of the short 
or medium incision into the long, together with 
another distinctive feature of his procedure : 



3 66 



MC D O WEL L ' S OPERA TION 



that of bringing out both ends of the ligature 
on the pedicle in the lower angle of the wound. 
Just how Dr. Chrysmar, in the little town of 
Isny, in the Kingdom of Wurtemberg (1819), 
obtained his first information regarding the 
reports of McDowell's first three cases, two 
years after their publication in the Philadelphia 
Eclectic Repertory (18 17), it would be difficult 
to say ; when in the United States Dr. Nathan 
Smith, Professor of Surgery in Yale Medical 
College, at New Haven (a little over one 
hundred and fifty miles from Philadelphia, and 
in close connection with the latter), had not 
apparently read or heard of McDowell's bril- 
liant operations at the time when he (Smith) 
performed his first operation of extirpation of 
an ovary three years later (1822). And yet 
the facts clearly show that Dr. Chrysmar had 
not only obtained this information in the face 
of the many obstacles then existing to inter- 
communication between foreign countries ; but, 
on the authority of Dr. Hopfer, Medical Super- 
intendent at Allgau, in 1819, he had even then 
already performed two operations, one with 
success ; making, as stated, with the three other 
reported cases after this date (18 19-1820), five 
cases, precisely the same number that McDow- 



IN GERMANY. 367 

ell had reported in his two papers embracing 
the period between 1809 and 181 9. Dr. Chrys- 
mar's results in these five cases (two cures out 
of the five), though far short of those achieved 
by McDowell (three cures out of five cases) in 
the far off little village of Danville, in the back- 
woods of Kentucky, certainly show a very fair 
average of success. If nothing more, they in- 
dicate an earnest and determined effort on his 
part to rescue a large class of women from a 
disease nearly always fatal, and hitherto left to 
the chances of incisionism, which then only was 
practised, and that only to a limited extent, in 
England and France. To Chrysmar, therefore, 
honor is due next to McDowell, and a position 
assignable to no other surgeon in Germany or 
any other country outside of the United States, 
and even here outside of the State of Kentucky, 
since to Chrysmar properly belongs the credit 
of having been the first to catch the inspiration 
of the "Father of Ovariotomy" and to place 
his convictions of the soundness of the princi- 
ples of the operation before the eyes of the 
profession of his own country, which, as the 
history of the subject shows, was not done by 
any one else there for more than half a century 
afterward. Such boldness and darino- as were 



-68 MCDOWELL'S OPERATION 

displayed by Chrysmar in these first trials of 
ovariotomy, under the circumstances stated, are 
deserving of the highest acknowledgment — yea, 
of a monument to perpetuate the nobleness of 
his example and the influence of it on his kind. 
May we not hope yet to see the high apprecia- 
tion of the deeds of this truly great surgeon and 
their value commemorated by the liberality of 
the profession of Germany ? A monument has 
been erected at Danville to the name and honor 
of the " Father of Ovariotomy " by the grateful 
profession of his own State, Kentucky, and one 
now erected to the memory of Chrysmar, the 
first to appreciate and perform ovariotomy any- 
where outside the State of Kentucky, would 
not only be a praiseworthy act on the part of 
the profession of his own country, but it would 
show a just appreciation of the claim properly 
belonging to the little town of Isny, near the 
border of Bavaria, and one of the free cities of 
Germany from 1365 to 1803, in which this 
historic achievement took place. 

To the other operations performed in Ger- 
many there is no special interest attached, 
except in the cases of Drs. Ehrhartstein and 
Dolhoff. The case of the former, it will be 
remembered, was the one in which the compli- 



IN GERMANY. ^g 

cation of pregnancy occurred, giving rise to 
enormous distention of the abdomen. Soon 
after labor, in which there is no special men- 
tion of difficulty, tapping was performed and 
two distinct cysts evacuated ; the fluid from one 
weighing twelve, and from the other fourteen 
pounds. From the circumstances there might 
have been inferred implication of both ovaries, 
the possibility of which had been shown in 
France some two-thirds of a century previously 
by an autopsy made by M. Malaval. Here 
there was likewise large and uniform disten- 
tion of the abdomen, resulting from ascitic 
effusion into the peritoneal cavity surrounding 
the two separate ovaries. This pair of ovaries 
weighed, respectively, twelve and fifteen pounds 
— figures corresponding almost precisely with 
those given by Dr. Ehrhartstein, and making a 
very extraordinary coincidence. 

About, or soon after, the period referred to 
in France (1750), Morand, in commenting upon 
dropsical ovaries and the several varieties then 
known to exist, speaks of the complication, 
sometimes, of the disease with pregnancy. He 
even cites a case in which the complication 
took place three times without any impairment 
of the general health, though the third gesta- 
24 



oyo MCDOWELL'S OPERATION 

tion failed to reach its full term. After this (at 
the end of the fourth year) the patient was 
tapped and twenty-five pints of fluid drawn off. 
In this connection the writer recalls a case of 
complicating pregnancy he operated upon six 
or eight years ago, in which the long incision of 
McDowell again proved of inestimable value. 
Here the complication not only co-existed with- 
out impairment of the general .health or diffi- 
culty in the labor, but the patient afterward 
nursed her child up to the time she applied for 
the removal of the tumor, five or six weeks 
after labor. She was then of the size of a 
woman at full term, and the result of the oper- 
ation was all that could have been wished con- 
sidering the existence of still another grave 
complication that was found seriously to inter- 
fere with the execution of the procedure. This 
second complication consisted of a calcareous 
deposit in the walls of the cyst, about one-third 
the size of the hand, to which was firmly adhe- 
rent a coil of small intestine. So firmly glued 
together were the peritoneal surfaces at this 
point that separation was found impossible. 
The difficulty, however, was overcome by split- 
ting the cyst wall, the scalpel being made to 
follow closely upon the external surface of the 



IN GERMANY. 37 1 

calcareous plate. In this way the correspond- 
ing part of the cyst wall was detached and left 
in its pathological relations with the intestine, 
to take care of itself afterward in the abdo- 
men ; which it did with no ulterior bad conse- 
quences, as proved by the final good result. 

Dr. Dolhoff refers to five cases (two uniloc- 
ular and three multilocular), together with one 
of false diagnosis in which an operation was 
unwarrantably performed. The interesting 
point regarding the treatment of the first class 
of cases named is that he employed the old 
method of incisionism with drainage and injec- 
tions. In this connection he speaks of using 
injections of red wine and a weak solution of 
nitrate of mercury ; and both cases in which 
they were tried terminated fatally (1829-33). 
The general plan pursued by him differed but 
little from that of Prof. Dzondi (18 16), he 
having been a pupil of the latter for several 
years, and, of course, familiar with his practice. 
It is in this connection that he avers most posi- 
tively that Prof. Dzondi entertained no special 
views upon the treatment of encysted dropsy 
of the ovaries, as claimed for him by Mr. John 
Lizars, and he expresses his surprise that the 
latter should ever have made a statement so 
erroneous. 



372 MCDOWELL'S OPERATIOX 

In two of the three cases of multilocular 
cysts referred to by Dolhoff there are several 
interesting points brought out. The first case 
presented a girth of fifty-three inches, and the 
tumor was uneven and more or less hard, with 
no distinct fluctuation at any point. From 
these and other peculiarities of the tumor and 
its surroundings, puncture of it with a trocar 
was deemed useless, and an exploratory inci- 
sion was consequently decided upon. For this 
the point of selection was to the left of the^ 
umbilicus, where a perpendicular opening two 
inches in length was made. The tumor was 
then punctured, but only a little dark fluid 
escaped from it. The incision was now ex- 
tended to a size sufficient to admit the hand 
into the tumor for the breaking up and removal 
of its contents as far as possible. At this stage 
of the operation (and this is an important point, 
showing the lack of appreciation of McDowell's 
long incision) a pair of forceps was introduced, 
and the posterior wall of the cyst (said to be 
an inch in thickness) was seized and drawn out, 
when a piece of it " the size of a man's hand " 
was cut off. With all this breaking up and 
excision of the cyst walls, the tumor still could 
not be drawn through the original opening. 



• IN GERMANY. 373 

Now it was thought advisable to extend the 
incision to seven or eight inches (McDowell's 
long incision), when, to the astonishment of all, 
the tumor, which had a pedicle, of the size of 
the little finder, at once became movable and 
could be lifted out of the abdomen. Next, a 
ligature was made to encircle the pedicle in 
mass ; but the operator, noting the large size of 
the divided arteries, afterward decided to re- 
move the first ligature put on and to tie each 
artery separately. To this mode of individu- 
ally tying the arteries he attached great value, 
and claimed originality for it. The case termi- 
nated fatally at the end of sixty hours. 

Now, considering the character of this tumor, 
its size (forty-six and a half pounds), the time 
taken up in the mutilation of its walls, and the 
delay in changing the ligatures, can anyone say 
that the long incision of McDowell, made at the 
outset, would not have been the proper thing 
to do ? Or, that the chances of saving the life 
of the patient would not thereby have been 
greatly increased ? 

Dr. Dolhoff, in his second case, made a 
medium incision, but, finding this insufficient, 
he at once extended it into the upper division 
of the abdomen, making it accord fully with Mc- 



374 MCDOWELL'S OPERATION 

Dowell's teachings. The removal of the tumor, 
however, could not be effected, and the case 
terminated fatally at the end of eight hours. 

Dr. Dolhoff, in his remarks upon the case of 
false diagnosis and the result of his operation, 
endeavored to explain the mistake as being 
mainly due to a spasmodic contraction of 
the abdominal muscles. He further remarks, 
strange as it may seem, that the patient was 
relieved in a great degree of all her old symp- 
toms, and remained so until the following April 
(1837), when they returned and became as 
troublesome as ever. After a long and inef- 
fectual trial of a seton in the abdominal wall, 
she was discharged unrelieved. 

Regarding the cystitis described in this case, 
whether or not it existed as cause or effect of 
the hysteria present, there was certainly a 
direct relationship between the two ; and this 
goes far to explain the cause of the error in 
diagnosis, and, consequently the uselessness 
of the operation that was performed. 

Dr. Dolhoff, in premising his report of this 
case, properly and justly remarks, that it is the 
duty of every surgeon to publish his mistakes 
as well as his triumphs, referring at the same 
time to the unfortunate operation performed 



IN GERMANY. 



375 



under like circumstances by an eminent British 



suro-eon. 



In such a diseased state of the bladder as 
found in Dr. Dolhoff's case, ureteritis or pye- 
litis, on one or both sides, was to be expected 
as a direct sequence, and the symptoms charac- 
terizing either one of these affections are just 
such as would lead a patient suffering from 
them for a long time to imagine that she might 
have a tumor in her abdomen, as he describes. 

As showing the wide range of bodily and 
mental sufferings (real and imaginary) closely 
related to some of the diseases of the genito- 
urinary organs, the writer has grouped the 
symptoms occurring in cases of this class 
according to the relation which cystitis bears to 
ureteritis and renal tenesmus, a relationship 
which he pointed out in a recent paper on the 
subject. 1 He has now the records of two cases 
in each of which incurable disease was declared 
to exist in both ovaries, by two eminent sur- 
geons, and they were respectively laparoto- 
mized successfully without the slightest benefit. 

1 Renal Tenesmus : A Result of Chronic Cystitis and Ureter- 
itis ; Successful Treatment by Kolpo-uretero-cystotomy and 
Intravaginal Drainage, combined with Elevation and Support 
of the Uterus and Ovaries. The Medical Record, August 4, 
1888. 



376 MCDOWELL'S OPERATION 

Afterward, by means of kolpo-uretero-cys- 
totomy, the writer diagnosticated in one case 
grave disease in both kidneys, as shown by the 
purulent discharge present, and in the other 
cystitis with ureteritis and renal tenesmus of 
the left side. Both the cases terminated 
fatally, and in one the autopsy revealed pyelitis 
calculosa in both kidneys. In the other case 
there occurred melancholia and refusal to eat, 
which terminated in insanity with hallucinations 
of a state of pregnancy and impending parturi- 
tion, and finally in death from starvation. The 
melancholia resulted directly from the realiza- 
tion of her unnecessary mutilation in the 
sacrifice of her ovaries, of which she herself 
became convinced after she had been relieved 
of her vesical, ureteral, and renal complications 
by the kolpo-uretero-cystotomy and the subse- 
quent intravaginal drainage. 

Such is the writer's view and explanation of 
the complications presented in Dr. Dolhoff's 
case, and of the circumstances that led him into 
the mistake of performing the unjustified oper- 
ation he describes, which arose, not from an 
error of judgment at the period of its perform- 
ance (as should here be noted to his credit), 
but, from a want of appreciation in surgical 



IX GREAT BRITAIN. ^77 

science at that date of the true relationship 
between the diseases of the uterus and its 
appendages, on the one hand, and the diseases 
of the bladder, ureters, and kidneys on the 
other, such as has just been pointed out. 



SECTION IV. 

Great Britain. 

The operation of tapping for the relief and 
cure of general dropsy, as a cause of impair- 
ment of health and obstruction of respiration 
and other important functions of the body, dates 
back, there is reason to believe, to the time of 
the Greeks and Romans. From the long-ac- 
cepted knowledge of the value of tapping for 
meeting the indications mentioned there is, also, 
reason to believe that encysted dropsy resulting 
from whatsoever cause, and in regard to the 
distinctive character of which no settled theory 
was held, was treated until within two or three 
centuries of our own time in the same way, and 
even cured, under favorable influences, now and 
then. But the precise period in the history of 
medicine at which the latter affection came to 



378 MCDOWELL'S OPERATION 

be specially studied and differentiated from 
general dropsy, and treated with an appreciation 
of its distinctive pathology, cannot now be satis- 
factorily determined. From all that I have been 
able to learn from my present investigation of 
the subject it is evident that this knowledge 
could not have existed long, if at all, prior to 
the beginning of the last century. There is 
reason to believe, however, that, independently 
of there not being any settled views among 
writers in regard to the differences between 
general and encysted dropsy, the operation of 
tapping in both affections, previously to the 
period named, had been more or less extended 
and improved by enlarging the trocar puncture 
by incision, for the better escape of the varying 
fluids and the easier introduction of a tent for 
drainage, the latter being used either alone or 
in conjunction (especially in the encysted va- 
riety) with injections. Whether or not this 
conclusion be correct with regard to the con- 
joined use of the knife, prior to the early date 
of which I am speaking, the case of Dr. Robert 
Houston, of Glasgow, Scotland, establishes the 
fact, beyond any question, that in 1701 he not 
only recognized the distinct form of encysted 
dropsy as differing essentially from that of gen- 



IX GREAT BRITAIN. 379 

eral dropsy, but suggested and executed an 
original procedure of incision, with drainage by 
tent in the lower division of the abdomen, curing 
his patient by the plan in the course of three or 
four weeks. In order to render this practice 
more distinctive I have termed it incisionism, 
and the surgeons who employed it incisionisis . 
This operation of Houston, so far as we know, 
inaugurated the practice of incision indepen- 
dently of tapping. I have previously referred 
to Houston's case in connection with several 
points in my study of encysted dropsy, and 
showed the influence of his method of incision- 
ism with drainage upon the practice of after 
years, especially in France, where the method 
was employed and enlarged upon by Le Dran, 
Delaporte, Theden, and L'Aumonier, up to the 
time that McDowell associated with it the ex- 
tirpation of the ovary by his long incision, 
embracing both the lower and upper divisions 
of the abdomen. 

From the importance of Houston's practice, 
and the credit due him for the advance he made 
upon the old operation of tapping, it is proper 
that the report of his case, with the description 
of his procedure and the result, should here be 
copied in full, this case marking the beginning 



380 MCDOWELL'S OPERATION 

of the treatment of a dropsical ovary by simply 
the short incision with drainage, without at- 
tempting removal of the diseased organ (1701), 
and by the long incision with extirpation of the 
diseased organ (1809.) 

I may, perhaps, be excused for trespassing 
upon the time of the reader for this purpose, on 
the ground that the old and rare work in which 
this case is recorded is not readily accessible for 
reference except to a few physicians. In addi- 
tion to this, certain unwarranted comments, 
affecting the claims of McDowell, that have been 
made upon the case by various authors, demand 
attention, and they can be better and more fairly 
made with all the facts relating to the case pre- 
sented in the author's own words. For exam- 
ple, John Gorham, Esq., of England, in his 
efforts to give importance to the Hunterian 
short incision, couples the history in part of 
this case with the cases of Dr. Nathan Smith, 
and Messrs. Jeaffreson, King, and West, in 
order to show that they were the first to com- 
prehend the true principles of the operation of 
extirpation of the ovary, forgetting that extirpa- 
tion of the organ, with extension of the practice 
of incisionism so as to include both the lower 
and upper divisions of the abdomen, were the 



TV GREAT BRITAIX. 



381 



essential features of the operation, and that to 
McDowell alone belonged the credit for these 

<z> 

innovations. 

The late Dr. W. L. Atlee, in the United 
States (1845), published his first " Table of Sta- 
tistics upon Ovariotomy, "without knowing about 
Houston's case, and introduced only the names 
of L'Aumonier, Dzondi, and Galenzowski, as 
preceding that of McDowell in point of priority. 
Discovering, however, from the London Philo- 
sophical Transactions, some four years later, 
his error in having omitted to place Houston's 
name in the list of previous operators, he ad- 
dressed a note to the late Dr. Isaac Hays, 
editor of the American Journal of the Medical 
Sciences, which was headed as follows : " Ova- 
rian Dropsy by the Long Abdominal Incision in 
1 701, by Robert Houston." 1 Accompanying it 
with a full copy of the report of the case, in 
quotation marks, under Houston's heading: "A 
Dropsy in the Left Ovary of a Woman, aged 
fifty-eight years, Cured by a Large Incision, 
Made in the Left Side of the Abdomen." In 
his corrected and enlarged table of cases of 
ovariotomy, published two years later, 2 he adds 



1 Op. cit., 1849, v °l- xv ii'» P« 534. 

2 Trans, of the Am. Med. Association, 185 1. 



382 



MCDOWELL'S OPERATLON 



Houston's name to the other three given, thus 
making the number of surgeons four who had 
preceded McDowell in the operation of ovari- 
otomy. His reprint of this publication bears 
the title: " A Table of All the Known Opera- 
tions of Ovariotomy, from 1701 to 1851, Com- 
prising Two Hundred and Twenty-two Cases, 
Including their Synoptical History and Ana- 
lysis." 

Still again, Professor Mapother, in an intro- 
ductory address on "Dublin Medical Schools," 
speaks at length of the "School of Surgery." 
In a published abstract of this address 1 I have 
found enumerated a great number of names of 
distinguished men connected with the history 
of this school, commencing with those of Mullen, 
the anatomist of the seventeenth century, and 
Proby, the first surgeon-general, and ending 
with those of Mr. Cusack, Professor Maccart- 
ney, Dr. Shekleton, and Dr. Houston. The 
writer, in concluding his notice of the last- 
named and his great work, the Catalogue of the 
Museum, says : 

"Toa namesake of Houston, and to a namesake of his 
contemporary, Ephraim McDowell, is assigned the first 
performance of ovariotomy. Professor Gross, in a memoir 

1 British Medical Journal, 1873, v °l- "•» P- 634. 



IN GREAT BRITAIN. 



383 



of the great Kentuckian of the latter name, asserts that in 
1809 he performed ovariotomy for the first time; but Dr. 
Mapother found, by the thirty-third volume of the Philo- 
sophical Transactions, that it was done successfully by a 
Dr. Houston in 1701." 

So much, then, for the injustice done Mc- 
Dowell's claim of originality in the first extirpa- 
tion of the ovary, and for the absurdity of any 
other claim for Houston than the important, 
and certainly the very creditable, one for his 
time of accomplishing the cure of his case by 
incisionism with drainage in the lower division 
of the abdomen. This had nothing whatever 
to do with extirpation of the ovary by the long 
incision made in both the lower and upper 
divisions of the abdomen, the achievement ac- 
complished by McDowell a little over one 
hundred and eight years later. 

With these necessary preliminary statements 

I now introduce the report of Dr. Houston's 

case 1 as published by him : 

"A Dropsy in the Left Ovary Cured," by Dr. R. Hous- 
toun. In August, 1701, I was desired to visit one Margaret 
Millar, a poor woman of 58 years of age, who lived not 
far from Glasgow, and lay bedrid of an uncommon disease. 
She inform' d me that her midwife having violently pulled 
away the burthen in her last lying-in, at 45 years old, she 

1 The Philosophical Transactions, N. 381, Jan., etc., 1724, 
p. 8. (From the year 1720 to the year 1732). Abridged and 
Disposed under General Heads, vol. vi., Part ii., iii., iv. 



384 MCDOWELL'S OPERATION 

was very sensibly affected by a pain which then seized 
her in the left side between the umbilicus and groin, and 
had scarce ever been free from it after, it having troubled 
her more or less during 13 years together; that for two 
years past she had been extremely uneasy, her belly grew 
very large, and a difficulty of breathing increased con- 
tinually upon her ; insomuch that for the last six months 
she could scarce breathe at all without the utmost diffi- 
culty That in all that space of time she had scarce eat 
so much as would nourish a suckling child, having quite 
lost her appetite, and that for the three last months she 
had been forc'd to lie constantly on her back, not 
daring to move at all to one side or other. This tumour 
drew towards a point, and was grown to so monstrous 
a bulk that it engross' d the whole left side from the 
umbilicus to the pubes, and stretch' d the abdominal 
muscles to so unequal a degree that I never saw the like. 
Her lying so continually on her back having greviously 
excoriated her, added much to her sufferings, which, with 
want of rest and appetite, had wasted her to skin and 
bone. I told her that in order effectually to relieve her, 
and remove the cause of the swelling, I must lay open a 
great part of her belly, but feared she would not be able to 
undergo such an operation : she seemed not at all fright- 
ened, but heard me without disorder, and, though scarce 
able to speak, urg'd me to perform it. I must confess I 
drew almost all my confidence from her unexpected resolu- 
tion, and without loss of time prepared what the place 
would allow, and with an imposthume lancet laid open 
about an inch ; but finding nothing issue I enlarged it two 
inches, and even then nothing came forth but a little thin 
yellowish serum ; so I ventured to lay it open about two 
inches more ; I was not a little startled to find only a 
glutinous substance stop up so large an aperture; but my 
great difficulty was to remove it; I tri'd my probe, I en- 
deavoured to do it with my finger, but all in vain ; it was 
so slippery that it eluded every touch and the strongest 



IN GREA T BRITAIN. 



385 



hold I could take. I wanted, in this place, almost every- 
thing necessary, but bethought myself of a very odd instru- 
ment, yet as good as the best, because it answered the end. 
I took a strong fir splinter, and having wrapt some lint 
about the end of it, I thrust it into the wound, and by 
turning and winding it drew out above two yards length of 
a substance thicker than any gelly, or rather like glue that's 
fresh made and hung out to dry ; the breadth of it was 
about ten inches ; this was followed by nine full quarts of 
such matter as I have met with in steatomatous and ather- 
omatous tumours, with several hydatides of various sizes 
containing a yellowish serum, the least of them bigger than 
an orange, with several large pieces of membranes which 
seemed to be parts of the distended ovary. Having 
squeezed out all I could, I stitched up the wound in three 
places almost equidistant; and, having no other but 
Lucatellus's balsam, with it I covered a pledget the whole 
length of the wound, and over that laid several compresses 
dipt in warm French brandy ; and because I judged 
that the parts might have lost their spring by so vast and 
so long a distention, I dipt in the same brandy a large 
napkin four times folded and applied it over all the dress- 
ings, and with a couple of strong towels, which were also 
dipt, I swathed her round the body, and then gave her 
about four ounces of this mixture : 

R. — Aq. menthse . . . . . lb.ss. 
Aq. cinnamomi fort .... lb.iss. 
Syr. diacodii ^vi. — M. 

— ordering her also to take two or three spoonfuls of it 
four times a day. The cinamon water was drawn off from 
canary and the best cinnamon. Next morning I found 
her in a bathing sweat, and she informed me with great 
joy that she had not slept so much nor found herself so 
well refreshed at any time for three months past. I care- 
fully dressed her wound in the same manner as above once 
a day for about a week ; I kept in the lower part of the 

25 



386 



MC D WEL L ' S OPERA TIOX 



wound a small tent, which discharged some serosities at 
every dressing for four or five days. But, business calling 
me elsewhere, I instructed her daughters how to dress the 
wound, and told them what diet I thought most proper, 
which was chiefly strong broth made of an old cock, in 
each porringer whereof was one spoonful of cinnamon 
water ; this she repeated four times a day, and it gave her 
new life and spirits. After three weeks' absence I called 
at her house, and finding it shut up was a little surprised, 
but had not gone far before I was much more so, for I 
found her sitting wrapt up in blankets and giving direc- 
tions to some labourers who were cutting down her corn. 
She mended apace, and lived in perfect health from that 
time till October, 1714, when she died after ten days' 
sickness." 

Having now shown the early labors of Dr. 
Houston by incisionism with drainage in the 
lower division of the abdomen, we are pre- 
pared better to appreciate the influence it had 
upon the profession, especially in France. Here, 
some thirty years later, it was taken up, as we 
have seen, by Le Dran (1736—46) and greatly 
improved upon by both him and Delaporte, the 
latter about 1750 making the first suggestion 
"to remove the focus of the disease, namely, 
the tumor formed by the ovary." Soon after 
Delaporte's important suggestion of the prefer- 
ableness of removing " the focus of the dis- 
ease" to that of simple incisionism in the lower 
division of the abdomen, Theden recommended 
a scheme of making a small incision in the in- 



IN GREAT BRITAIN. ^g/ 

guinal region, somewhat as Le Dran had done 
in his first case, based upon the theory that the 
diseased ovary was always to be found outside 
of the peritoneum, in which situation it could be 
exposed, punctured, drawn out, and ligated, 
and thus be strangulated or amputated, as cir- 
cumstances called for. Theden proposed this 
procedure, as indicated, purely upon theoretical 
grounds, and there is no evidence to show that 
any one ever put it into practice, though it was 
highly commended by Morand, and somewhat 
enthusiastically endorsed at the time by Drs, 
Power and Darwin, in England. These points 
have been fully brought out in the French his- 
tory of the subject, and do not here call for 
further comment. 

With regard to the influence that Theden's 
theory of an operation for the removal of a 
dropsical ovary had upon the practice of Great 
Britain, at the period of which we are speaking, 
I am without the necessary data to speak posi- 
tively. 

Dr. William Hunter, in England, about the 
same period that Theden, in France, is credited 
with his proposal, called into question the views 
then entertained regarding the scirrhous origin 
of the dropsical ovaries, mainly brought out in 



^gg MCDOWELL'S OPERATLON 

the latter country, claiming that many little 
bags, or cysts, found one within another on the 
inside of a "dropsical ovarium" were not scir- 
rhous." He thus took the lead in advocating a 
more-advanced step regarding the pathology of 
the disease, and the basis of his views is found 
in a communication entitled "The History of 
of an Emphysema," 1 by William Hunter, M.D., 
read October 31st, 1757, before a society of 
physicians in London. Under this title he dis- 
cusses, in addition to emphysema, "the cellular 
membrane and some of its diseases," together 
with general and encysted dropsy of the ovaritim, 
with attending ajzasarca. He states that he 
had seen a great many cases of " encysted 
dropsy of the ovarium," both in the living and 
in the dead, and that he had never seen one in 
which there was a perceptible diminution of the 
enlargement by any other plan of treatment 
than by the trocar. He thought that the ana- 
sarca of the lower extremities attending this 
disease was less amenable to relief by incisions 
than the same result attending general dropsy. 
He further held that encysted dropsy of the 
ovarium was incurable, remarking that "a 
patient will have the best chance of living 

1 Med. Observations and Inquiries, London, 1762, vol. il., p. 41. 



IN GREA T BRITAIN. 



389 



longest under it who does the least to get rid 
of it." Surgeons of the highest reputation, he 
adds, had proposed and advocated "a radical 
cure by incision and suppuration (incisionism), 
or by excision of the cyst," but the former prac- 
tice could only be pursued under particular cir- 
cumstances, and the latter hardly admitted of 
an attempt. 

Dr. Hunter's views with regard to the origin, 
growth, and complications of the disease, and 
his proposed plan of ''excision of the cyst," 
which he thought might be employed under 
extreme circumstances, together with his ob- 
jections to the procedure by incisionism, are 
concisely stated in the following quotation : 

"I can hardly say that I have ever found any part of a 
dropsical ovarium in a truly scirrhous state. What at first 
view might seem such proved, upon cutting, to be a com- 
pact group of small bags, or a spongy substance filled with 
gelly. 

"Generally, before the patient dies of such a dropsy, 
some degree, both of leucophlegmatia and of ascites, is 
brought on, so that when such bodies are opened some 
water is found loose in the cavity of the belly, and some- 
times the cyst is found to have burst, and to have dis- 
charged its contents into that cavity. 

" Now, if the disease be nearly what I have stated, must 
not the wound made in the belly for the excision of the 
cyst or cysts always be large enough to admit the surgeon's 
whole hand? Must it not be often a good deal larger, as 
when the tumor is large, and composed of a number of 



390 



MC D WELDS OPERA TION 



bags filled with gelly? Would not such a wound be 
attended with a good deal of danger from itself? Would 
it not be very difficult to cut the peduncle, or root of the 
tu?nor, with one hand only introduced ? Would it not be 
impossible to do this, where the adhesions proved to be 
considerable? Would there not be great danger of wound- 
ing the intestines? If any considerable branch of the 
spermatic artery should be opened, what could the surgeon 
do to stop the bleeding? If it be proposed, indeed, to 
make such a wound in the belly as will admit only two 
fingers, or so, and then tap the bag, and draw it out, so as 
to bring its root or peduncle close to the wound of the 
belly, that the surgeon may cut it without introducing his 
hand, surely in a case otherwise so desperate it might be 
advisable to do it, could we beforehand know that the cir- 
cumstances would admit of such treatment. 

"With regard to incision and suppuration, all that is 
proposed to be got by this painful operation is the change 
of the dropsy into an incurable fistula in the belly. For 
this the patient must not only undergo much pain, but 
likewise be exposed to great danger, particularly where the 
cyst happens not to adhere to the muscles at the part where 
the incision is made, or where there are a number of cysts. 
In the first case, the wound will be a large one, communi- 
cating with the cavity of the abdomen, and both the exter- 
nal air and the contents of the incised cyst, will be admitted 
into that cavity, so that we may expect very considerable 
inflammation. In the second case, where there are a num- 
ber of cysts, the inflammation and suppuration will either 
be too slight to discharge all of them, or too considerable 
to be supported with life." 

From this presentation of Dr. Hunter's views 
on the pathology of ovarian dropsy, together 
with his theoretical operation for the removal 
of this disease, it must be confessed that credit 



IN GREA T BRITAIN. 39 x 

is due him for having attained a clearer insight 
into the nature of the disease and a more prac- 
tical comprehension of what sort of a procedure 
was called for for its removal than any one who 
had ever written upon the subject before. It 
was virtually an intelligent and practical re- 
sponse to the timid suggestion of Delaporte in 
France, after his disastrous failure by the old 
method of incisionism a few years previously, 
"to remove the focus of the disease — namely, 
the tumor formed by the ovary." With strong 
common sense he suggests that the opening in 
the abdomen should at least be large enough 
to admit the surgeon's hand for the required 
manipulations of the tumor, and that even an 
opening of this size might not prove sufficient 
when adhesions and complications with neigh- 
boring viscera existed, with the danger of hem- 
orrhage that was liable to attend any effort to 
overcome such obstacles. In regard to a small 
opening by a short incision he had also a clear 
conception of just what was barely necessary 
to enable the surgeon under favorable circum- 
stances to expose the cyst, tap it, draw it out, 
and excise "its root or peduncle close to the 
wound of the belly." Whether or not he 
thought constriction of the pedicle before exci- 



3Q2 MCDOWELL'S OPERATION 

sion necessary he does not state, but that he 
did may be inferred from his mention of the 
danger of wounding the spermatic artery in the 
operation. 

In his proposal of a short incision is seen the 
influence exerted upon him by the previous 
teachings of the incisionists, requiring the open- 
ing to be made in the lower division of the 
abdomen, as limited by a transverse line at the 
umbilicus ; but the exact mode he describes of 
making the incision of a certain length, admit- 
ting ''two fingers or so," is unquestionably 
original. There is nothing in the history of the 
subject to the date of McDowell's operation 
that approaches his proposed method for clear- 
ness of conception as to the kind of an opening 
in the abdomen necessary for the removal of a 
dropsical ovary composed of one, two, or three 
cysts. Appreciating the principle, as we do 
now, we cannot fail to wonder why there was 
no surgeon in Great Britain to profit by Hun- 
ter's teachings until after McDowell had led 
the way fifty-two years later, combining with 
a long incision the all-important step of extir- 
pation of the ovary. Whether McDowell was 
familiar with his theory of an operation for ex- 
tirpation of the ovary there is nothing to show, 



IN GREAT BRITAIN. 393 

further than the fact that he was a medical stu- 
dent in the University of Edinburgh during the 
session of 1 793-94, and while there listened to 
the lectures of Mr. John Bell, one of the most 
eminent surgeons of that day. But whether or 
not while there he learned anything definite 
reearding- the theoretical views of either Theden 
or Hunter (and this is certainly a matter of 
great doubt, to say the least), is of no prac- 
tical importance, since it was thirteen years 
after his return to the United States that he 
encountered in the backwoods of Kentucky, 
where he was thrown entirely upon his own 
resources, his first case of dropsical ovary. Un- 
der these circumstances, what mode of proce- 
dure do we find him following ? Was it by the 
old method of making a small opening in the 
lower division of the abdomen as formerly em- 
ployed by the old incisionists, notably by Hous- 
ton, Le Dran, and Delaporte, and as extended 
in theory by Theden and Hunter? No, it was 
by the long incision that properly bears his 
name, made (though outside of the rectus mus- 
cle) in both the lower and the upper divisions 
of the abdomen, from the margin of the ribs to 
the os pubis ; thus affording opportunity for 
the fullest exposure of the tumor, the widest 



394 MCDOWELL'S OPERATION 

possible range for the manipulation of the same, 
the discovery of complications, and the preven- 
tion of accidents. 

Dr. Nathan Smith, who, as we have seen, 
was the first surgeon in the United States to 
imitate McDowell in the extirpation of a drop- 
sical ovary (July 5, 1822), in his case followed 
almost precisely the theory of Dr. Hunter in 
puncturing and drawing out the collapsed cyst 
through a short incision. In fact the whole 
procedure was carried out by him on the theory 
of the cyst being small and simple, and on the 
line of old incisionism in the lower division of 
the abdomen, but combined with the practical 
and essential features of extirpation of the 
ovary by the long incision, as previously taught 
by McDowell, the account of which original 
practice had then been published over five 
years, and was familiar to the profession at 
home and abroad. 

As the facts stand in medical history, Dr. 
Smith published the case, the same year as the 
operation, 1 without mentioning McDowell's 
name or alluding to his operation in the 
slightest way. The result was that for a long 
time his publication, either by itself or in con- 

1 Op. cit. 



IN GREA T B RITA IX. t>9$ 

junction with those of Mr. John Lizars, of Edin- 
burgh, was frequently quoted by writers, who 
spoke of these operators, if not as originators 
of the procedure, certainly in such a way as to 
greatly disparage the claims of McDowell. 

With this review of incisionism for the treat- 
ment of a dropsical ovary and the relation of 
the practice to that of extirpation of the dis- 
eased organ, we come to the direct study of the 
influence of McDowell's completed operation 
of ovariotomy by the long incision upon British 
surgery from the date of the first employment 
of it by Mr. Lizars 1 to the time of its revival in 
England, September, 1842, by Dr. Charles 
Clay. 

Mr. Lizars in his first communication, which 
is entitled " Observations on Extirpation of the 
Ovaria, with Cases," by John Lizars, F.R.S.E., 
F.R.C.S.E., and Lecturer on Anatomy and 
Physiology, Edinburgh, commences by quoting 
in French the concluding paragraph of the 
report of the case of supposed extirpation of 
the ovary by M. L'Aumonier, as quoted in 
the French history of the subject, of which the 
following is a translation : 

1 Edinburgh Medical and Surgical Journal, Oct. 1824, vol. xxii. 
p. 247. 



396 



MCDOWELL'S OPERATLON 



" This example and that of total amputation of the 
uterus and vagina, performed with success, justify the con- 
clusion that, with a thorough knowledge of anatomy, there 
are but few organs upon which one may not perform with 
advantage the different operations of surgery." 

After stating that Le Dran and Dzondi had 
each cured dropsy resulting from disease of the 
ovary by incision and tent (incisionism), the lat- 
ter removing the sloughing sac by the forceps, 
he quotes Morand regarding the removal of the 
healthy ovaries in quadrupeds, and Felix Plater 
and Diemerbroeck, to show that the practice in 
women was not chimerical, as proven by a cus- 
tom among the Lydians ; Paulus Barbette, to 
show he had opened the abdomen for disen- 
gaging a strangulated intestine ; Bonetus, as 
claiming that relief was afforded a lady in 
a similar condition by the same operation, 
performed by a military surgeon ; and Schacht, 
as having secured a similar satisfactory result 
by the same method. Furthermore, to prove 
the practicability and safety of abdominal sec- 
tion, he recalls the well-known practice of the 
Caesarean operation, and refers to the classic 
case in which the same operation was per- 
formed six times successfully. He then adds: 

" But the practicability of extirpating a diseased ovarium 
does not rest on theory. It has been proved by experi- 



IN GREAT B RITA IX. ^Q7 

ence. L'Aumonier, who was chief surgeon of the great 
hospital at Rouen about fifty years ago, extirpated the 
ovarium successfully ; and since his time an ovarium has 
been repeatedly removed, and sometimes with success, par- 
ticularly in France, Germany, and America. Dr. Smith, 
of Connecticut, lately extirpated an ovarium in a dropsical 
state successfully. Three very instructive cases occurred to 
Dr. Macdowal, of Kentucky, and the following history of 
them was sent, about seven years ago, to the late celebrated 
surgeon, Mr. John Bell, who was then on the Continent, 
and came into my hands as having the charge of his pa- 
tients and professional correspondence during his absence." 

Here follows the report of the three cases 
of McDowell, from the manuscript that had 
remained unacknowledged and unpublished, in 
his possession, for seven years, and he gives the 
narration of these important cases entirely with- 
out comment or remark, though making a few 
verbal corrections and transpositions in the text. 

This brings us to the report in detail of Mr. 
Lizars's case of false diagnosis and unjustifiable 
operation, in which the incision made was that 
of McDowell. He states that in the year 182 1 
he was requested by his friend, Dr. Campbell, 
to examine a woman, aged twenty-seven, with 
an enlargement of the abdomen equal to that 
ordinarily met with in pregnancy in full term. 

" On examination the tumor occupied the whole abdomi- 
nal cavity, and appeared to roll from side to side. The 
woman stated that the enlargement began six years pre- 



398 



MCDOWELL'S OPERA TLON 



viously in the left side, and that she assigned the cause of 
it ' to several blows and kicks received from a brutal hus- 
band.' She further stated that some two years after it 
commenced she had noticed ' a small movable swelling 
in her left groin, which she allowed to increase for twelve 
months, when she came to Edinburgh, and, on consulting 
a surgeon, he opened it with a lancet, and discharged a 
large quantity of thin matter.' This was thought to be 
a ' lumbar abscess, ' which she ascribed to a fall on her back 
three years previously." 

The patient, after consulting the " chief medi- 
cal gentlemen " of Edinburgh, many of whom 
pronounced her case one of pregnancy, and all 
of whom dissuaded her from an operation, 
finally came to Mr. Lizars for the removal of 
the supposed tumor. He, 

"convinced, from the history of the disease in the records 
of medicine, and from gastrotomy having been successfully 
performed for volvulus, and from the Caesarean section, 
that there was little to apprehend either from loss of blood 
or peritoneal inflammation," 

decided to make an effort to relieve her of her 
sufferings by an operation, choosing, as men- 
tioned above, the procedure of McDowell by 
the long incision. He, accordingly, performed 
the operation October 23, 1823. This was six 
years after he had received McDowell's manu- 
script containing the report of his first three 
cases, and one year after the publication of the 
report of Dr. Nathan Smith's operation. 



IX GREAT BRITAIN. ^qq 

Suffice it to say that the diagnosis of Mr. 
Lizars in this case was not only proved by 
McDowell's long incision to be wholly false as 
to the existence of an abdominal tumor that 
"appeared to roll from side to side," but that 
by means of the incision it was possible to 
discover 

"a flattened tumor of no great magnitude, at the left 
sacro-iliac synchonchosis of the pelvis, lying beneath the 
division of the common iliac artery, into its external and 
internal branches." 

By this little pelvic investigation of Mr. Lizars 
he did more, though in an unconscious way (as 
implied by his general description) to prove the 
value of the long incision, embracing both the 
lower and upper divisions of the abdomen (as 
opposed to old incisionism), than McDowell 
had ever done in any one of his three cases. 
Such an investigation in the pelvis, resulting in 
such a diagnosis of the growth and its relations 
to the soft parts found to exist, would have been 
wholly impossible by the incision made in Dr. 
Smith's case, in which, in his history of the sub- 
ject, Mr. Lizars gives so marked a degree of 
prominence. Could Mr. Lizars only have ap- 
preciated this fact, and brought it fairly to the 
notice of the profession, this improved mode of 



400 



MCDOWELL'S OPERATION 



pelvic investigation would have gone far toward 
lessening the horror created on all sides and in 
all directions by his performance of such an un- 
necessary operation. But, as it was, he failed 
to do this in his report of the case, and by the 
minute description of certain details of his ope- 
ration which might just as well have been 
omitted, he, himself, unconsciously or ignorantly, 
largely contributed toward increasing the pre- 
judice at that time existing against the proce- 
jure, as will presently be shown. For example, 
there occurred (as in McDowell's first case) a 
protrusion of the intestines through the incision, 
and he descants upon this as follows : 

"When the intestines protruded, and baffled all the 
efforts of Dr. Campbell and the other gentlemen to con- 
fine them, I shall never forget the countenances of my 
pupils and the younger members of the profession. This 
fact of the intestines being forced out proves, along with 
others, that the lungs can be expanded although atmos- 
pheric air be admitted into the abdominal cavity; the 
diaphragm acted with great vigor and with powerful 
impetuosity." 

Fortunately for Mr. Lizars, however, the 
poor woman recovered from her operation in 
the course of three or four weeks. She after- 
ward resumed her work, " earning her liveli- 
hood as formerly, by binding shoes, but often 
severely tortured with pain." 



IN GREA T BRITAIN. ^ Q l 

In explanation of his mistake in diagnosis 
and his unjustifiable operation Mr. Lizars 
says : 

" The reason why all of us were deceived in this woman's 
case was the great obesity and distended fullness of the 
intestines, together with some protrusion pelvic of the 
spine at the lumbar vertebrae." 

Mr. Lizars, from what he had learned from 
the manuscript of McDowell and the result of 
his own case, came to the conclusion "that 
there is little danger to apprehend in laying 
open the abdominal cavity," and that the pro- 
cedure would have a wide range of applicability 
outside the employment indicated — viz., for 
extrauterine conception, for the prevention of 
embryulcia of the foetus in deformities of the 
pelvis, for aneurisms involving the iliac arteries 
and aorta, for removal of foreign bodies from 
the stomach, for volvulous, for internal hernia, 
and for cancer of the uterus. He considered 
the dangers resulting from delay under these 
circumstances greater than would result from 
the timely employment of such an operation as 
he had performed. 

The following year Mr. Lizars published 
three additional cases in a paper entitled "Ob- 
servations on Extraction of Diseased Ovaria ; 
26 



4 o2 MCDOWELL'S OPERATION 

Illustrated by Plates Colored after Nature." 1 
A brief summary of the cases is here given : 

Case II. — Patient, aged thirty-six, presented herself with 
a tumor in the left side, of six years' standing and the size 
of a foetus at full term. Operation February 27, 1825. 
McDowell's procedure ; full exposure of the peritoneal 
cavity ; ligatures on the pedicle brought out in lower angle 
of wound. Upon examination the other ovary (right) was 
found to be also diseased and about one-fourth the size of 
the one removed, but Mr. Lizars decided for some reason 
not to remove this, probably on the supposition of unwar- 
ranted risk. The wound was closed in the usual way and 
the patient recovered. 

Case III. — A cookmaid, aged twenty-five, presented 
herself to Mr. Lizars with an abdominal tumor of six years' 
standing. McDowell's operation, March 22, 1825. In 
this instance the incision was curvilinear through the broad 
muscles, tendons and peritoneum. Some parietal adhe- 
sions were found, but these were easily overcome by the 
fingers. The pedicle was the size of the little finger. It 
was encircled with a ligature and the tumor cut away. 
The wound was closed with sutures, and adhesive strips, 
with compress, and a shawl was made to serve as a binder. 
The ends of the ligatures were brought out at the lower 
angle of the wound. Peritonitis supervened and the pa- 
tient died at the end of fifty-three hours. 

Case IV. — A cookmaid, aged thirty-four, presented her- 
self to Mr. Lizars with an abdominal tumor of six years' 
standing. McDowell's operation performed April 24, 
1825. The tumor was found to be covered by the great 
omentum, in which numerous bloodvessels, varying from 
the size of the finger to that of a crow's quill, were seen to 

1 Abstract of the same, Edinburgh Med. and Surg. Journ., 
July, 1825; also, Archieves Generale de Medecine, t. viii., 
P- 437- 



IN GREA T BRITAIN. 



403 



ramify. No attempt was made to dissect the omentum 
from the tumor, and further efforts to complete the opera- 
tion, other than to puncture the tumor in several places 
(from which only blood escaped), being deemed inadvisa- 
ble, the wound was closed and dressed as in the preceding 
cases. The patient recovered. 

It is proper here to note the effect which the 
publication by Mr. Lizars of McDowell's first 
three cases, and of his own of false diagnosis 
and unjustifiable operation, had upon the pro- 
fession, judging from the criticisms and ridicule 
found in the Medico-Chirurgical Review for 
January, 1825, and October, 1826, by its editor, 
Dr. James Johnson. 

Dr. Johnson, in his first remarks upon the 
subject, says that the exploits of surgery cannot 
always be accepted as real advances, and ex- 
presses surprise at the importance attached by 
Mr. Lizars to the operation of McDowell, to 
whom he refers slightingly as "Dr. Mac" and 
" Dr. Macdowal, of Kentucky." He then pro- 
ceeds to accentuate what he considers the im- 
probabilities of McDowell's statements, espe- 
cially as they related to his first case, that of 
Mrs. Crawford. Thus, the patient travelling 
sixty miles on horseback to receive the care 
and attention of Dr. McDowell at his own 
home in Danville, and having her abdomen laid 



404 



MCD WELL'S OPERA TION 



open to the extent of nine inches ; the protru- 
sion of her intestines for twenty-five minutes 
through the wound made in her abdomen ; the 
laying open of the tumor; the excision of it; 
and the patient's getting up on the fifth day to 
make her bed, when McDowell, from his report, 
appears to have made his first visit, were all 
extraordinary statements, and he was not a 
little surprised that Mr. Lizars " should put 
such implicit credence in them"; adding, 
Credat Jtidczas, non ego. He expresses the 
same incredulity in regard to McDowell's state- 
ment of the management of his second case of 
irremovable tumor (fibrous growth of the 
uterus, no doubt), in which, by way of experi- 
ment he " plunged the scalpel into the diseased 
part," and found "a quart or more of blood 
escaped into the abdomen." 

The great prejudice of Dr. Johnson against 
the operations and results described by Mc- 
Dowell is further illustrated by his even ignor- 
ing the successful case of Dr. Nathan Smith, 
the report of which appears in Mr. Lizars's first 
communication. Mr. Lizars's description of his 
own case, however, he thought was altogether 
different from McDowell's account of his cases, 
and the fact of the operation by Mr. Lizars 



IN GREAT £ RITA IX. 



405 



being penormed and no tumor found he recog- 
nized as a most fortunate circumstance, because 
his "patient would have had little chance of 
life." As it was, she recovered, "and lives to 
tell the tale." After quoting Mr. Lizars's ex- 
planation of the cause of his mistake in diag- 
nosis, he concludes : 

"Be that as it may, we do not think that the cases 
brought forward in this paper will have the effect of ren- 
dering surgeons more bold in operating for the removal of 
abdominal tumors, whether ovarian or of any other kind." 

Just after the publication of the first case of 
Mr. Lizars the able work of Professor James 
Blundell appeared, entitled : Researches, Physio- 
logical and Pathological : instituted principally 
with a View to the Improvement of Medical and 
Surgical Practice. Dr. Johnson, in a lengthy 
review of this book (April, 1825), just after his 
strictures upon McDowell's operations, takes 
occasion to criticise the words of Professor 
Blundell regarding the extirpation of dropsical 
ovaries : 

"And if British surgeons will not patronize and perform 
it, the French and American surgeons will ; ' ' 

making use of the extraordinary statement : 

"In despite of all that has been written respecting this 
cruel operation, we entirely disbelieve that it has ever been 
performed with success — nor do we think it ever will." 



4<d6 MCDOWELL'S OPERATLON 

A little over a year after the appearance of 
Mr. Lizars's second publication, in which his 
three additional cases are recorded (1825), four 
years after Dr. Nathan Smith's case was pub- 
lished (1822), and seven years after the publi- 
cation of McDowell's second paper (1819), 
containing the report of his fourth and fifth 
cases, Dr. Johnson, in his second editorial 
(1826) seems for the first time to be aroused 
to the injury he had done McDowell and his 
operation, which resulted, as he indirectly ad- 
mits, more from the loose manner of the nar- 
ration of his cases than from the facts stated. 
Here, at this late day, he endeavors to make 
amends for his error, as shown in his opening 
remarks in the editorial referred to : 

"A back settlement of America — Kentucky — has beaten 
the mother country, nay, Europe itself, with all the boasted 
surgeons thereof, in the fearful and formidable operation 
of gastrotomy with extraction of the diseased ovaria. ' ' 

Here follows a brief notice of McDowell's 
fourth and fifth cases, special reference being 
made to the fourth, in which ligatures were 
"applied to several arteries individually," and 
also to the fact that both of these cases were in 
negresses. In the same communication he intro- 
duces a notice of Dr. Nathan Smith's case, the 



IN GREAT BRITAIN. ^ y 

result in which he ignored in his first notice. 
He also mentions the successful operation in a 
negress by Dr. Alban G. Smith, at Danville, 
Kentucky, which he speaks of as " still the 
scene of operations." 

It is clear from reading Dr. Johnson's second 
review of McDowell's operations that he was 
finally forced to the acknowledgment of his 
error by the reply to his first remarks by Dr. 
Coates, 1 in which the latter upheld the just 
claims of McDowell, deduced from the actual 
facts of his live cases, four of which recovered. 
" For which uncharitableness we ask pardon 
of God and of Dr. Macdowal, of Danville," he 
exclaims ; but, notwithstanding this, he goes on 
to say that he was "in good company" with 
" Diemerbroeck and Sabatier, who believed the 
operation to be altogether impracticable." In 
the same connection mention should be made of 
his persistent ridicule of the large proportion of 
negresses among McDowell's cases. He says: 

" When we come to reflect, that all the women operated 
upon in Kentucky, except one, were negresses, and that 
these people will bear cutting with nearly, if not quite, as 
much impunity as dogs and rabbits, our wonder is lessened, 
and so is our hope of rivalling Dr. Macdowal on this side 
of the Atlantic." 

1 North America Med. and Surg. Journ., 1826, vol. hi., p. 30. 






4 08 MCDOWELLS OPE RATION 

Next, in England, following in the footsteps 
of Mr. Lizars in the employment of [McDowell's 
operation is an Italian physician living in Lon- 
don, by the name of Augustus Bozzi, but better 
known as Dr. A. B. Granville. He encountered 
two cases of ovarian dropsy in the Westminster 
General Dispensary, where he was one of the 
attending physicians. His first operation was 
an unfinished one, and the report is entitled : 
" Case in which an Attempt was made to Ex- 
tirpate Ovarian Tumors." 1 

Case V. — Operation performed July i, 1826, in the 
presence of Mr. Benjamin Brodie, Mr. Keate, Mr. Earle, 
and several others. Mr. Brodie had previously seen this 
case in consultation with Dr. Granville and they both 
agreed that the case was not favorable for an operation ; 
but, nevertheless, it was deemed advisable under the cir- 
cumstances. The incision made was seven inches and a 
half in length, in the left side external to the rectus muscle, 
and made in accordance with the teachings of McDowell. 
Dr. Granville, in passing his hand into the peritoneal 
cavity, found several tumors having extensive and firm 
adhesions, and, therefore, he concluded (in which opinion 
he was supported by the surgeons present, who examined 
the condition of the parts) that an attempt at removal of 
the tumors was not warranted. The wound was closed 
with hare-lip pins, and the patient recovered. 

The report of the case concludes in these 
words : 

1 London Medical and Physical Journal, 1826, vol. lvi., p. 141. 



IN GREAT B RITA IX. 



4O9 



"As far as it goes, this case adds another to the many 
instances on record of the impunity with which the cavity 
of the abdomen may be laid open, and is an encouraging 
step toward attempting, under proper circumstances, and 
after mature deliberation, an operation, which Mr. Lizars, 
of Edinburgh, has the merit of having revived on rational 
grounds." 

Case VI. — Entitled: "Extraordinary Surgical Opera- 
tion." 1 The patient, aged forty, presented herself to Dr. 
Granville for treatment, suffering with an abdominal tumor 
the size of the human head. McDowell's long incision 
was employed, as in the preceding case, March 21, 1827, 
in the presence of Mr. Keate, Mr. Eade, Mr. Patterson, 
and several other physicians. The tumor weighed eight 
pounds and was removed entire. The patient died seventy- 
two hours after the operation from exhaustion due to ex- 
cessive loss of blood from venesection by an over-zealous 
student, who thought peritonitis was present. 

In connection with Dr. Granville's two opera- 
tions it is proper to state the fact that some 
fifteen years after the date of his second opera- 
tion he found himself compelled to defend his 
claims to having been the first in England to 
perform ovariotomy. 2 This he did in answer 
to the statement made by Mr. D. Henry 
Walne 3 that after Mr. Lizars the operation of 
ovariotomy sunk into a state of apathy, so to 
speak, and was not revived by any British sur- 
geon until within a few months previously, 

1 Literary Gazette, March 31, 1827. 

2 London Medical Gazette, 1842-43, vol. xxxi. 

3 Op. cit. 



410 MCDOWELL'S OPE RATI OX 

when Dr. Clay (September 21, 1842) per- 
formed an ovariotomy, followed by his 
(Walne's) a few months later (November 6). 
To this Dr. Granville replies : " Mr. Walne 
assumes the credit which belongs to another," 
and in support of his claim he adduces the facts 
as brought out in the above two cases. 

Of the various publications credited to Dr. 
Granville, from 18 19 to 1858, it is curious to 
note that not one is mentioned as bearing upon 
the operation of ovariotomy, nor is any refer- 
ence made to the two operations performed by 
him in London in The Roll of the Royal College 
of Physicians of London (of which College he 
was a member), which contains a biographical 
sketch of him. 

The next British surgeon in order who was 
led to adopt the long incision of McDowell is 
Mr. R. C. King, 1 of Saxmundham, Suffolk, 
England, as appears from his communication 
entitled : " New Operations for the Removal of 
Abdominal Tumors." His reasons given for 
reporting the appended cases are principally to 
show the safety of the operation, and to en- 
courage further efforts in the employment 
of it: 

1 Lancet, Jan. 7, 1837, vol. i., p. 586. 



IN GREA T BRITAIN 



411 



Case VII. — This patient (the first) presented herself to 
Mr. King with a large and irregular tumor, with general 
distention of the abdomen and distinct fluctuation. After 
four tappings, from which relief always resulted, partially 
as to the embarrassed breathing, an operation for the re- 
moval of the tumor was decided upon. Dr. Field and 
several other physicians were present, and assisted in the 
operation. A long incision was made along the left linea 
semilunaris, through which a considerable quantity of 
ascitic fluid escaped, together with the omentum. Whilst 
he was endeavoring to return the omentum the patient 
"became discomposed, and expressed a wish that the 
attempt might be abandoned." Accordingly, as soon as 
the omentum was returned the wound was closed, and, 
although the patient recovered from the unfinished opera- 
tion, she died from exhaustion a few months afterward. 

Case VIII. — Mr. King's second case was Sophia Put- 
tock, aged forty, who presented a " movable abdominal 
tumor. ' ' It was in the right side, oval in form, and four 
or five inches in its longest diameter. Mr. William Jeaf- 
freson, of Framlingham, who was called in consultation to 
see the case, corroborated the diagnosis of Mr. King, and 
expressed the opinion that removal of the tumor was called 
for. Operation, March, 1834. Present, Mr. Jeaffreson, 
Mr. Lanchester, and five other physicians. An incision, 
seven or eight inches in length, was made along the right 
semilunaris. The tumor not being found through this 
incision, it was enlarged transversely toward the lumbar 
vertebrae. Further search for the tumor was made in the 
direction of the liver and right kidney, the latter being 
"handled and held up two inches," but nothing of a dis- 
eased character could be discovered. The peritoneal 
cavity, in this fruitless examination, was exposed about 
twenty minutes. The wound was closed with sutures, 
and the patient made a speedy recovery. 

Mr. King states that in his abdominal search 



412 MCDOWELL'S OPERATLON 

for the tumor he neglected to elevate the hips 
of his patient, which might have caused the dis- 
lodgementof the tumor from the pelvis, where it 
was probably concealed, and suggests that this 
precaution might prove of advantage to other 
surgeons placed under like circumstances. Mr. 
King further states that at the end of two or 
three years, when he reported the case, notwith- 
standing the increase of the tumor from one- 
fourth to one-third beyond its former size, the 
patient was in better health, and suffered less, 
than at the time of his unfinished operation, a 
fact which he attributes to the relaxation of the 
abdominal wall on the right side, resulting from 
imperfect union of the edges of the wound, the 
cicatrix being formed simply by the integu- 
ments. 

Mr. King's third case will be presented further 
on, for the reason that the extirpation of the 
diseased ovary was effected by the short inci- 
sion. This was previously suggested, as has 
been shown, by Dr. William Hunter, as the 
outgrowth of the old method of incisionism. 
Mr. King, however, attributes the credit of the 
procedure to his friend, Mr. William Jeaffreson, 
stating that he had previously operated upon 
a case by the short incision, and that it was 



IN GREA T BRITAIN. 4 x 3 

upon the result of this that his case followed, as 
"a scion grafted upon the parent stock." 

Mr. Jeaffreson, in his report 1 of the case re- 
ferred to, entitled : " A Case of Ovarian Tumor 
Successfully Removed," states that in an expe- 
rience of thirty years he had met with about 
twenty cases of dropsical ovaries, and that the 
tendency of all of them was to a fatal termina- 
tion, after varying periods of protracted suffer- 
ing. The treatment employed, consisting prin- 
cipally of tapping, although affording temporary 
relief, was at best only a "forlorn hope," not- 
withstanding the contrary claims made by Sir 
Astley Cooper, Dr. Haighton, and a few others. 
He then states that he was cognizant of the 
fact that " Dr. Smith once performed this opera- 
tion with success," and goes on to say that 
" Mr. Lizars had published many interesting 
cases of extirpation of the ovary," thus show- 
ing that he must have been ignorant of Dr. 
McDowell's original operation, or that he con- 
siders its special features of no practical advan- 
tage. In giving his own views he says : "It has 
often occurred to my mind that the operation 
might be had recourse to so soon as the sac was 
sufficiently distended as to press firmly on the 

1 Trans. Prov. Med. and Surg. Asso., 1837, vol. v., p. 239. 



4 I4 MCDOWELVS OPERATION 

parietes of the abdomen, and before adhesions 
had taken place." He states that he was led, 
in 1833, to this conviction from meeting with a 
case of ovarian dropsy, complicated with preg- 
nancy at full term, in which the descent of the 
tumor retarded the process of labor until he 
lifted it up with his finger, and thus overcame 
this grave obstacle to the passage of the child's 
head. This woman died a few days afterward, 
and as an illustration of the soundness of his 
convictions, just stated, he rehearsed at the 
autopsy the stages of an operation by which 
he believed the woman's life might have been 
saved. 

The plan indicated, and which he proposed 
to follow when the opportunity again offered, 
embodied these features : First, to make an 
incision in the linea alba midway between the 
umbilicus and the pubes, about an inch in 
length ; second, to expose and puncture the 
cyst with a trocar ; third, during the flow of the 
fluid, to seize a portion of the cyst wall " in the 
grip of the forceps " ; fourth, the sac being 
emptied, to draw it gradually through the 
opening, puncturing any other cyst or cysts as 
they presented themselves ; fifth, to include the 
pedicle in a ligature, cutting the ends "off close 



IN GREA T BRITA IN 4 T 5 

to the knot" and dropping the pedicle " into 
the cavity of the abdomen " ; and, sixth, in the 
after-treatment to use large doses of opium 
with foxglove, " keeping a napkin wrung out of 
the coldest spring- water constantly applied over 
the whole of the abdomen," as first recom- 
mended by Mr. King. With these preliminary 
statements, he proceeds to narrate his case : 

Case IX. — In November, 1833, Mr. Jeaffreson was 
called to see Mrs. B. in her second confinement, and, by 
an extraordinary coincidence, he discovered the case to 
be similar to the one just referred to as terminating fatally. 
The same line of treatment was pursued with success, and 
the child delivered without difficulty. His friend, Mr. 
King, was called in consultation. Nearly three years 
afterward (March 4, 1836), Mr. Jeaffreson was again 
called in to attend Mrs. B. in her confinement, and the 
child was born without difficulty. But he was surprised to 
find afterward that the size of the abdomen was but 
slightly diminished, a circumstance due to the gradual 
augmentation of the dropsical ovary during the interval 
that had intervened between the two labors. After a lapse 
of two months, during which time all the ordinary reme- 
dies for promoting absorption of the fluid present, includ- 
ing veratria, so highly extolled by Dr. Turnbull, had been 
resorted to without permanent benefit, the patient decided 
to submit to an operation for removal of the tumor. 
Operation by Mr. Jeaffreson, May 8, 1836, assisted by Mr. 
King. The incision made was said to be " between ten 
and twelve lines." The different steps of the operation 
were carried out as in the plan previously described, and 
the wound closed, only two sutures being called for. The 
patient perfectly recovered. 



416 



MC D WELL'S OPERA TLON 



Mr. Jeaffreson goes on to state that after the 
recovery of his patient he received a thesis 
written by Dr. Charles Frederick Quittenbaum, 
on the successful treatment of a case of drop- 
sical ovary operated upon November 18, 1834, 
but he (Jeaffreson) had the same objection to 
this operation that he had to those of Mr. 
Lizars, viz. : " The greater extent of the incision 
and consequent hazard to the patient," referring 
here, of course, to the McDowell incision. He 
then concludes the report of his case by saying 
that if he had met with extensive adhesions 
between the cyst and the surrounding viscera 
he would have established a communication 
between the former and the peritoneal cavity, 
thus leaving the diseased organ to be cured by 
peritoneal absorption. In this is seen the most 
pointed acknowledgment of the defectiveness 
of the Hunterian short incision he had just 
adopted in the face of a difficulty that would 
not have been of the slightest consequence in 
the employment of McDowell's long incision. 
The expedient here referred to, of establishing 
a communication between the cyst and the 
peritoneal cavity in cases otherwise irremedi- 
able by the short incision, was a proposal pre- 
viously made by Prof. Blundell. 



IN GREA T BRITAIN. 4 1 y 

Mr. Jeaffreson here mentions the case of Mr. 
R. C. King previously referred to by the latter, 
as "a scion grafted on the parent stock," and 
which now follows in regular order. 

Case X. — Mr. King's third case, entitled "Ovarian 
Dropsy ; Removal of the Cyst ; Employment of Cold and 
Foxglove after Operation." 1 H. C, a teacher, aged 
thirty-seven, applied to Mr. King, in August, 1833. She 
presented an enlargement of the abdomen, with fluctua- 
tion. Mr. King says that, previous to seeing Mr. Jeaffre- 
son's case, he had decided to allow this patient to go on 
until she was incapacitated from her duties, and then tap 
her to obtain the usual temporary relief; but the result of 
Mr. Jeaffreson's case proving so satisfactory, he was led to 
perform the same operation without further delay. Oper- 
ation July 12, 1836, at which Mr. Jeaffreson was present 
and assisted. The operation was virtually the same as that 
of the latter, except that, after drawing off twenty-seven 
pints of gelatinous fluid, he had to enlarge his incision to 
three inches in order to extract the sac. It should also be 
stated that, after applying the ligature to the pedicle in 
mass, it slipped off and had to be reapplied, which was 
done on the arteries individually, one of which was the 
size of the ulnar artery. The three ligatures applied were 
cut off close to the knots, and the pedicle returned to the 
abdomen. The bleeding was slight. After the operation 
Mr. King gave two drachms of tincture of foxglove and 
one of laudanum ; and immediately after the operation 
began the application to the entire abdomen of thick 
cloths wrung out of ice-water, frequently renewed. Sec- 
ond day, little or no tenderness of the abdomen; pulse 60. 
At no time since the operation had the pulse exceeded 64. 
But little nausea or hiccough. On the third day condi- 

1 Op. cit., January 7, 1837. 
27 



J 



4i8 



MCD O WELL'S OPERA TIOX 



tion of patient normal, and from this time on convales- 
cence was as satisfactory as it was possible to be. Patient 
cured. 

Mr. King concludes the report of this case 
with the following remarks : 

" These cases will, I think, materially add to our confi- 
dence in the powers of the human frame to dispose of 
ligatures when left in cavities The applica- 
tion of the ice-water was continued incessantly to the 
abdomen ; it was injected into the rectum and colon 
in large quantities and frequently. Nutritious fluids of 
animal broth, milk, and gruel were likewise given through 
the same medium. Foxglove acted very favorably in 
overcoming the tendency to quickened circulation, and it 
was frequently repeated during the first fortnight, although 
chiefly through the medium of the bowels in consequence 
of the irritability of the stomach. It would be occupying 
too much of your publication to add my observations on 
the use of cold and foxglove to counteract inflammatory 
tendencies, either after operation or in idiopathic inflam- 
matory disease, but I think there will be little difficulty in 
showing that, when fully and assiduously used, they have 
most important and controlling powers in arresting the 
march of the destroying power of inflammatory disease, 
chronic or acute." 

Mr. W. J. West, of Tunbridge Wells, was 
the next to report a case of ovariotomy, and it 
was entitled, "Successful Operation for the 
Removal of an Ovarian Tumor." x He pre- 
cedes the narration of his case by reference to 

1 Lancet, 1837-38, vol. i. p. 307. 



IA r GREA T BRITA IN. 4 j q 

the two published reports of the cases of 
Messrs. Jeaffreson and King, and to the objec- 
tions that had been made to the report of the 
former by the London University Medical 
Society. 1 

Case XI. — Mrs. H., aged forty-four, was attended by 
Mr. West in her third confinement, the pregnancy being 
complicated by a tumor in the abdomen of thirteen years' 
standing. Mr. West had previously examined the patient, 
and knew the character of the tumor. She had consulted 
several surgeons, and had been treated by a seton, as 
recommended by Dr. Barnard, and by various other 
remedies. Operation November 2, 1837, Mr. West being 
assisted by Dr. Scudamore and Mr. Hargraves, also of 
Tunbridge Wells. Incision in the linea alba below the 
umbilicus, two inches in length ; then the tumor was 
exposed and secured by a loop of cord fixed in the sub- 
stance of the wall, preparatory to puncturing the cyst with 
a trocar. Twenty pints of fluid were drawn off, when, by 
very little traction on the loop, the emptied cyst was 
extracted from the peritoneal cavity. A ligature was 
applied to the pedicle in mass, the ends cut off close to the 
knot, and the tumor removed, the pedicle being returned 
to the abdominal cavity. Four sutures were used for 
closing the wound, which was also supported by strips of 
adhesive plaster. In the after-treatment " cold spirituous 
lotions were constantly applied over the abdomen," and 
calomel with saline aperients were given for keeping the 
bowels open. Patient was discharged cured. 

In Mr. West's concluding remarks he sum- 
marizes the objections of the London University 
Medical Society referred to regarding Mr. Jeaf- 

1 Lancet, January 7, 1837. 



420 MCDOWELL'S OPERATLOX 

freson's plan of operating. They were : First, 
inapplicability of the procedure when adhesions 
had formed; second, ''the danger of perito- 
nitis " ; third, " when the cysts are numerous "; 
and fourth, " the disease being complicated with 
other tumors." 

Mr. West performed three other operations 
according to the suggestions of Mr. Jeaffreson, 
which are not reported in detail, but he fur- 
nished Mr. John Gorham, of Tunbridge, Kent, 
for publication, the essential points of his treat- 
ment and the results, which the latter recorded, 
together with the cases of Dr. Nathan Smith, 
Mr. Jeaffreson, Mr. Hargraves, and the case in 
Guy's Hospital, in an article entitled: "Obser- 
vations on the Propriety of Extirpating the 
Cyst in Some Cases of Ovarian Dropsy." 1 

Case XII. — Mr. West's second case, Miss S., aged twenty- 
five, presented an abdominal tumor with distinct fluctua- 
tion. Short incision, exposure of the cyst, and emptying 
the sac (which contained twenty-four pints of fluid), car- 
ried out as in the preceding case. No unfavorable symp- 
toms attended the after-treatment. The patient was cured. 

Case XIII. — Mr. West's third case. Mrs. Tompkins, 
aged forty, had an abdominal tumor which had previously 
been tapped. Short incision. Adhesions found and no 
attempt made to remove tumor, which was probably mul- 
tilocular and, therefore, unsuitable for short incision. 

1 Lancet, 1839-40, vol. i., p. 155. 



IA ' GREA T BRITA IN. 4 2 I 

Wound was closed and patient recovered. She was 
tapped seventeen times afterward. 

Case XIV. — Mr. West's fourth case. A. M., aged 
twenty-four. Similar case to his third, and short incision 
was made. " Sac contained eleven gallons and her con- 
stitution was much shattered." Mr. West's statements to 
Mr. Gorham regarding this case are vague, but enough is 
brought out to show that the tumor was multilocular in 
character, and, therefore, unsuited for removal by the 
short incision. Eight pints of fluid withdrawn. Tumor 
was not removed. "Tapped repeatedly before she 
sank." 

In this connection Mr. Gorham refers to two 
other cases, the details of which are unpub- 
lished : that of Mr. Hargraves, and the one in 
Guy's Hospital. 

Case XV. — The case of Mr. Hargraves, of Tunbridge 
Wells. A. B., aged forty. Fluctuation distinct in the 
abdomen. The solid portion of the tumor could be felt 
through the abdominal wall. Short incision made. Pres- 
ent Mr. Gorham. Tumor found with adhesions. Opera- 
tion abandoned and wound closed. Tumor was probably 
multilocular and, therefore, unsuited for removal by short 
incision. 

Case XVI. — Patient in Guy's Hospital. Operation 
(unfinished) was performed in 1839. Fluctuation of 
tumor distinct. Short incision as in the preceding cases. 
More extensive exploration, and greater traction made 
than was thought justifiable. The tumor being probably 
multilocular, the operation was unfinished. Patient died, 
and the autopsy showed but slight adhesions. Tumor un- 
suited for the short incision. Operator not named, but sup- 
posed to have been Mr. Morgan, and the case was the first 
one operated upon in any of the great hospitals of London. 



422 



MC DO WELL'S OPERA TLON 



Mr. West exhibited at Guy's Hospital the specimen of the 
cyst removed in his first case in 1839, and there is con- 
siderable direct evidence that Mr. Morgan, who was at 
that time one of the surgeons at Guy's, performed the 
operation in question. 

After the publication of Mr. Gorham's ten 
cases, and his comments upon them and their 
results, accompanied by an allusion to the prior 
proposal of Dr. William Hunter in connection 
with the possible extirpation of dropsical ovaries 
by a short incision, Mr. Jeaffreson, feeling that 
these remarks reflected upon his originality, 
addressed a letter to the editor of the Lancet 
(November 2, 1839) upon the subject, in an- 
swer to Mr. Gorham, in which he says : 

" I beg to say that I was perfectly sincere in claiming 
the more simple mode of operating in these cases as a sug- 
gestion of my own mind, never having seen or heard of 
Dr. Hunter's paper on the subject. Indeed, I think that 
it is the deference which has been paid to the gigantic 
authority of John Hunter, more particularly to his theory 
of 'Continuous Sympathy,' which has kept abdominal 
surgery in comparative abeyance." 

Mr. Gorham, 1 in his rejoinder to Mr. Jeaffre- 
son, disclaims any intention of reflecting upon 
the merits of Mr. Jeaffreson's proposal of the 
short incision, and admits the looseness of his 
statements regarding the prior suggestions of 

1 Lancet, Dec. 9, 1839. 



IN GREAT BRITAIN. 423 

Dr. Hunter. This done, he expresses his ap- 
preciation of Mr. Jeaffreson's contribution to 
science in these words : 

"It does seem we are indebted not only for what we 
know of real utility and benefit, as regards this particular 
operation, but also for opening to us a new era in the 
surgery of the abdomen." 

In the letter of Mr. Jeaffreson's just referred 
to he alludes to a successful operation of " ex- 
tirpation of an ovarian cyst," by his friend, 
Mr. Crisp, of Harleston, Norfolk, and this is 
here introduced in its regular order. 

Case XVII. — This patient consulted Mr. Crisp in re- 
gard to an abdominal tumor of about twenty years' stand- 
ing, and for which she had submitted to two tappings. 
Length of incision supposed to be short. No adhesions 
found with surrounding viscera, or from previous tappings. 
Cyst punctured, and three gallons of fluid drawn off, after 
which the collapsed cyst was removed without difficulty. 
Perfect cure. 

Next follows Mr. Benjamin Phillips's case. 
His report is entitled : " Extraction of an Ova- 
rian Cyst." 1 Mr. Phillips in the prefatory 
remarks to the report of his case, deprecates 
in a commendable way the reprehensible ten- 
dency of surgeons to report only their suc- 
cessful cases, "as if any moral imputation could 

1 London Med. Gaz., 1840-41, vol. xxvii., p. 83. 



424 MCDOWELL'S OPERATLOX 

attach to failure in cases where failures must 
often happen." He considered such a practice 
not only "immoral," but tending to retard the 
true and legitimate advance of the art of sur- 
gery. Without going into the history of the 
operation for extirpation of ovarian cyst, he 
says : 

" For all practical purposes it is sufficient to assume that 
to Mr. Jeaffreson (1836) belongs any merit which may- 
attach to the plan of treating these cysts, by extraction 
through a short incision in the abdominal parietes." 

Case XVIII. — A. D., aged twenty-one, with an abdomi- 
nal tumor, having previously consulted several surgeons in 
London, among whom were Mr. Liston and Dr. Hamilton 
Roe, finally came through the latter to Mr. Phillips. No 
question as to diagnosis. Operation by Mr. Phillips, Sep- 
tember 9, 1840, at which were present and assisted Drs. 
Roe, Clendening, Harrison, and Messrs. Prichard, Brown, 
and several others. Short incision below the umbilicus, 
an inch and a half in length. Cyst exposed, seized with 
forceps, punctured with trocar, and three hundred and 
thirty ounces of transparent, glairy fluid drawn off; no 
adhesions, but walls of cyst found thick, requiring the 
opening to be enlarged a little so as to facilitate extraction. 
Pedicle small, firmly tied with a ligature, ends cut off close 
to the knot, tumor removed, and the pedicle allowed to 
return to the abdominal cavity. Wound closed with 
sutures. After the operation the patient almost im- 
mediately began to complain of pain in the right iliac 
fossa. On the third day she was attacked with severe 
diarrhoea, a " choleriform affection," for which opium and 
astringents were freely given, and twelve leeches applied. 
Case terminated fatally at the end of one hundred and 



IN GREAT BRITAIN. 



425 



three hours. Autopsy showed the ligature of the pedicle 
to be in place, but eight ounces of blood in the peritoneal 
cavity. 

Summary of cases and results in Great 
Britain of extirpation of dropsical ovaries by 
McDowell's procedure, including alike those 
operated upon by the long and short incisions : 
9 completed operations, with 6 cures and 3 
deaths ; 8 unfinished operations, with 7 recov- 
eries and 1 death ; 1 unjustified operation, with 
recovery. Mortality of completed operations, 

33-33 P er cent - 

Comments. — Encysted dropsy of the ovary as 
distinguished from general dropsy, or ascites, 
was, as we have seen, first recognized as such, 
and successfully treated by incision and drain- 
age, in a woman, Margaret Millar, aged fifty- 
eight, residing near Glasgow, Scotland, by Dr. 
Robert Houston, in August, 1701. To Great 
Britain, it is believed, is justly due the credit of 
first adopting the practice designated as inci- 
sionism, and the circumstances of Houston's 
operation, with the result noted, mark an im- 
portant era in the history of the subject, not 
only on account of its being the first case in 
which incisionism was employed, but from the 
influence it had upon the practice of other coun- 



426 



MC D WEL L ' 5 OPERA TION 



tries, leading, as it did, to the proposal of ex- 
tirpation of the ovary nearly half a century later 
in France. In still another particular the case 
is important, as has been shown, viz., in its 
having been claimed by one writer over a hun- 
dred years later as a case of successful ovari- 
otomy by the long incision, and again by 
another only a few years ago, who made the 
same claim on the assumption that a namesake 
of this old Scotch physician had catalogued, in 
a most creditable way, the anatomical museum 
-of a school of surgery. 

In the contribution of Dr. William Hunter, 
offering a more advanced explanation of the 
pathology of ovarian dropsy, with his sugges- 
tion of the possibility of extirpating a simple 
and small cyst through a short incision in the 
abdomen, there is much of practical value to 
commend, and for this also Great Britain has a 
just claim of credit, his position being on the line 
of advancement through old incisionism, as 
inaugurated by Houston. This theoretical pro- 
position of Hunter, however, was not accepted 
by any surgeon of that country, nor was even a 
trial of it made there, until extirpation of drop- 
sical ovaries became a settled fact three-quarters 
of a century later. Nevertheless, it was a 



IN GREAT BRITAIN. 427 

movement in the right direction, as proven by 
the readiness with which surgeons took up the 
short incision in the lower division of the abdo- 
men, as proposed by Hunter, after McDowell 
had demonstrated the practicability of his oper- 
ation by the long incision. How much Mc- 
Dowell profited by the teachings of Hunter it 
is difficult to say, but the boldness displayed by 
him in his first movement of securing the widest 
exposure of "the focus of the disease, namely, 
the tumor formed by the ovary," as suggested 
by Delaporte, shows conclusively that to master 
adhesions and to avoid injuries of the surround- 
ing organs were with him considerations of 
paramount importance, a conception of the 
operation far beyond the simple thought of a 
short incision involving all the dangers incident 
to tugging at and dragging through such an 
opening a tumor of unknown dimensions. Fur- 
ther proof that the conception of McDowell was 
independent of any ideas derived from Hunter 
is shown in the fact that he made an entrance 
into the abdomen above the tumor, so to speak, 
instead of below, as had been advocated by 
Hunter, and was always the practice of the inci- 
sionists. The final abandonment of the short 
incision of Hunter, in England, after a few years' 



i 



428 MCDOWELL'S OPERATION 

trial of it, and the return there to the long in- 
cision of McDowell, may be considered conclu- 
sive, it is thought, not only as to the originality 
of the procedure of the latter, but as to the 
correctness of the principles upon which it 
rested. 

Mr. Lizars deserves special mention, not 
only on account of his being the fifth surgeon 
to employ McDowell's operation of ovarotomy 
by the long incision, and of the results he se- 
cured from the procedure, but because of his 
unwarranted neglect for seven years to acknowl- 
edge his accidental possession of the report of 
McDowell's first three cases of extirpation of 
the ovary. His first case, the one of false 
diagnosis and unjustifiable operation, proved, 
of course, most unfortunate for the procedure, 
and threw a damper upon it in the estimation 
of the profession in Europe for many years. 
His second case (one of double ovarian dropsy), 
reported as being successful, was unsatisfactory, 
to say the least. One ovary, it is true, was 
removed, but the woman was left in a state of 
continual dread of having to go through with 
the same ordeal for removal of the other, and 
after a few years she finally died, from the re- 
maining disease, in this state of mind. Double 



IX GREAT BRITAIX. a 2 q 

ovarian disease was not unknown at the date of 
this operation by Mr. Lizars, though the facts 
show that this was the first time that tumors of 
both ovaries had been encountered in an opera- 
tion. As brought out in the French history, 
M. Malaval, in the early part of the last cen- 
tury, found in an autopsy both ovaries to be the 
seats of tumors, one weighing twelve pounds 
and the other fifteen pounds. Mr. Lizars, there- 
fore, acted without a precedent, and, although 
wrongly, did the best he knew how under the 
circumstances. He could have removed both 
ovaries just as well, with but little increase of 
risk, and it was the proper thing to have done. 
The case has an additional interest in being the 
first in Great Britain to recover from the opera- 
tion of extirpation of an ovary, and, in conse- 
quence of this fact, aside from the incomplete- 
ness of the result, it elicited a good deal of 
attention there from the profession. It is said 
that the woman (whether at the instance of Mr. 
Lizars, I do not know) came from Edinburgh to 
London on a visit, and was there the subject of 
several examinations by prominent physicians, 
notably by Prof. Blundell, the greatest advo- 
cate of the operation that had been performed, 
and by Dr. James Johnson, the greatest critic 



43<D MCDOWELL'S OPERATLON 

and denouncer of it at that date of its trial. 
The third case of Mr. Lizars was a completed 
operation, but it terminated fatally at the end of 
fifty-three hours. In his fourth case the opera- 
tion was unfinished, but the patient recovered. 
These three operations of Mr. Lizars, affording 
the occasion of his second paper, were all per- 
formed within two months (February 27, April 
24, 1825), and the results attending them, 
together with that of his previous case of false 
diagnosis, show pretty conclusively, it would 
seem, why he cut short his experience in this 
kind of surgery — an experience not uncommon 
among operators in like cases from that day 
down to the present time. This experience of 
Mr. Lizars had a notable precedent, in the days 
of incisionism, in the operation of Delaporte, 
where, after opening the abdomen and the 
tumor, and thus giving vent to sixty-seven 
pounds of gelatinous fluid in the course of 
eleven days, when death put an end to the 
scene, he wisely suggested that instead of this 
kind of work, it would be preferable "to remove 
the focus of the disease, namely, the tumor 
formed by the ovary." As we have seen, he 
even advised that this improved operation 
should be performed in the early stage of the 



IN GREA T BRITAIN. 43 x 

disease, but on account of his past experience 
in operating he does not appear to have had 
any desire, himself, to engage in the practice 
suggested, and here ended, it seems, his mis- 
sion as an operator. So it was with Mr. Lizars. 
Such is the experience of operators still, in even 
less grave operations than those referred to, 
and so it may be expected to continue under 
like circumstances in the future. 

As regards the conduct of Mr. Lizars toward 
Dr. McDowell, in withholding his manuscript, 
sent to Mr. Bell for publication, for seven years 
without acknowledgment, and then publishing 
it in connection with a case of false diagnosis 
and unjustified operation, there is nothing that 
can be said in extenuation of such neglect of 
duty and injustice. The simple statement of 
the facts is all that is needed here. These 
carry their own condemnation. 

As to the unjust criticisms of the McDowell 
operation and the retraction of the same by Dr. 
Johnson, they speak for themselves, as we have 
seen in connection with the two papers of Mr. 
Lizars and the results of his former opera- 
tions. 

As to the four operations following Mr. 
Lizars's, by Dr. Granville and Mr. King, in 



432 MCDOWELL'S OPERATION 

which the long incision of McDowell w r as em- 
ployed, there is certainly but little to be said 
further than that they proved unsatisfactory: 
one terminating fatally, and three being left 
unfinished, though with recovery. The two 
operations of Dr. Granville are deserving of 
note as being the first performed in London, 
one July 21, 1826, and the other early in 
1827. 

In connection with Mr. King's second case, 
the fact is worthy of special mention that he em- 
ployed in the after-treatment large doses of 
opium with tincture of digitalis and cloths over 
the abdomen wrung out of cold spring-water, 
and finally ice-water — an addition to the anti- 
phlogistic practice then in vogue, both valuable 
and creditable to his judgment as a surgeon. 

This brings us to the case of Mr. William 
Jeaffreson, of Framlingham, who, influenced by 
the case of Dr. Nathan Smith in the United 
States, as we have seen, was the first to revive 
and make trial of the short incision in the lower 
division of the abdomen, as proposed by Dr. 
William Hunter on the line of the old incision- 
ism. The idea which Mr. Jeaffreson had in 
view in taking up this old method of incisionism 
was precisely the same that influenced the old 



IN GREA T BRITA IN. 4 33 

incisionists, namely : to operate early, when the 
tumor was below the umbilicus, and situated 
more or less on one side or the other, and the 
quality of the fluid, as determined by tapping, 
was such as to lead to the conclusion that the 
tumor was simple and uncomplicated. 

In the study and investigation of this class of 
cases, where the tumor was liable, at any stage 
of its development to the size when the opera- 
tion was called for, to become complicated with 
pregnancy, very close differentiation between 
the two kinds of enlargement became neces- 
sary, and thus great advance had already been 
made when Mr. Jeaffreson came to recognize 
this complication in a case of the kind which he 
afterward operated upon. As has been men- 
tioned, M. Morand, about two-thirds of a cen- 
tury previously, had called attention to the 
possibility of such a complication ; citing, as he 
did at that early day, a case in which it occurred 
three times, little or no inconvenience being 
caused until the third time, when the pregnancy 
failed to reach full term. It will also be recalled 
that a case complicated with pregnancy came 
under the observation of Dr. Ehrhartstein, in 
Germany, and that he successfully performed 
McDowell's operation just after labor ; a trans- 
28 



j 



434 MCDOWELL'S OPERATION 

lation from the German report of it appearing 
in the Medico- Chirurgical Review^ July, 1833, 
the same year Mr. Jeaffreson encountered his 
first case. The latter says that it had often 
occurred to him that the operation of extirpa- 
tion of a dropsical ovary ought to be attempted 
as soon as the tumor began to distend the 
abdominal wall, and before adhesions had taken 
place, points he insisted upon as being a sine 
qua 11071 to success ; and that he was led to 
these conclusions from encountering a case in 
which the tumor proved an obstacle to the 
descent of the child's head (1833). The 
patient died a few days afterward, and, learning 
from the autopsy that no adhesions existed, he 
decided upon a plan of removing such a tumor 
by operation, as previously mentioned. Mr. 
Jeaffreson, it would seem from this, was familiar 
with the published case of Dr. Ehrhartstein, and 
was no doubt led into the same line of investi- 
gation thus foreshadowed. This point, I think, 
is made clear from the fact that, four months 
after the publication of Dr. Ehrhartstein's case 
in England (November, 1833), Mr. Jeaffreson 
was called to see Mrs. B. in her second labor, 
and found the co-existence of a small dropsical 
ovary, a condition of things similar to that 



IN GREAT B RITA IX. 



435 



found in the case previously cited. The tumor 
was pushed up out of the way, and the labor 
terminated satisfactorily. Again, on March 4, 
1836, the third labor occurred, and terminated 
in a satisfactory way, without a recurrence of 
the former difficulty. About two months later, 
the patient having become anxious about the 
size the tumor had attained, and having been 
informed of the danger she was in, decided to 
submit to an operation for its removal, which 
Mr. Jeaffreson performed May 4, 1836. The 
result, as we have seen, proved completely 
successful. 

From these circumstances and dates it is 
fair to infer that Mr. Jeaffreson, in his investi- 
gation regarding the relative advantages of the 
short incision and McDowell's long incision, 
profited not only by the teachings of his coun- 
tryman, Dr. William Hunter, upon this point, 
but by the previous experience of Dr. Nathan 
Smith with the short incision, together with 
that of Dr. Ehrhartstein, as has been pointed 
out in relation to the complication of ovarian 
dropsy by pregnaney. When he made an in- 
cision midway between the navel and the pubes 
in the linea alba "between ten and twelve 
lines " in length for the removal of a tumor 



436 MCDOWELL'S OPERATLON 

which he knew to be small, and probably with- 
out adhesions (practical information derived 
from nearly three years' observation of its 
growth and behavior through two pregnan- 
cies), he had only to seize it with a pair of 
forceps, puncture a cyst or two, and draw it 
through the incision, as one would remove a 
tent from a sinus. But if, contrary to expecta- 
tions, there had been found adhesions of the 
tumor to the surrounding parts, he would, as he 
takes the precaution to tell us, have established 
communication between the interior of the cyst 
and the peritoneal cavity, thus leaving the col- 
lapsed w 7 alls of the former to take care of 
themselves in a new relationship. This is an 
expedient previously suggested by Prof. Blun- 
dell in connection with the old method of 
incisionism. How different was the prospect 
before Dr. Ehrhartstein in the contingency of 
his meeting with such a complication in his 
case, possessing, as he did, the advantages 
afforded by the long incision of McDowell for 
discovering and successfully dealing with adhe- 
sions or any other existing complication. And 
where was the superiority of the short incision 
and the manipulation of the tumor employed 
by Mr. Jeaffreson, over the practice taught him 



IN GREAT B RITA IX. ^7 

seventy-four years previously by the publication 

of his own countryman, Dr. William Hunter, 

in the following words ? 

"If it is indeed proposed to make such a wound in the 
belly as will admit only two fingers or so, and then to 
tap the bag and draw it out so as to bring its root or 
pedmicle close to the wound of the belly, that the surgeon 
may cut it without introducing his hand, surely, in a case 
otherwise so desperate, it might be advisable to do it, 
could we beforehand know that the circumstances would 
admit of such treatment." 

The favorable circumstances in Mr. Jeaffre- 
son's case were the previous complications of 
two pregnancies, and a fairly thorough under- 
standing, acquired on these occasions, of the 
simple and even the uncomplicated character 
of the "bag" of fluids co-existing. 

But even in a case so simple as the one 
described by Mr. Jeaffreson, where the cyst can 
apparently be so easily removed through an 
opening in the lower division of the abdomen, 
the procedure adopted is liable to be followed 
by serious results, as we learn from Mr. Jeaffre- 
son himself. On the fifth day after the opera- 
tion there appeared symptoms of very grave 
and threatening import, which he describes in 
his report of the case as follows : 

"I found her with incessant vomiting, hiccough, pulse 
scarcely to be felt, considerable griping pain in the 



438 



MC D WELL'S OPERA TLON 



bowels, and an aching, shooting pain along the course of 
the anterior crural nerve." 

Here is a state of collapse resulting no doubt 
from injury, and perhaps slow hemorrhage. 
The attending peritonitis was held in check and 
finally controlled by large doses of opium with 
tincture of digitalis, and cloths wrung out of 
ice-water applied continuously over the abdo- 
men, as had been employed previously and 
recommended by his friend, Mr. King, of Sax- 
mundham. To this treatment was largely due, 
no doubt, the final good result. 

Mr. John Gorham/some four years after the 
publication of Mr. Jeaffreson's case, in speaking 
of excision of the ovary by both the long and 
short incisions, made the same quotation from 
the publication of Dr. William Hunter I have 
given, and Mr. Jeaffreson took exception to 
this, publishing in the Lancet a communication 
in which occurs the following statement : 

" I beg to say that I was perfectly sincere in claiming the 
more simple mode of operating in these cases, as the sug- 
gestion of my own mind, never having seen or heard of 
Dr. Hunter's paper on the subject. Indeed, I think it is 
the deference which has heen paid to the gigantic authority 
of John Hunter, more particularly to feis theory of ' Con- 

1 Lancet, 1839-40., vol. i., p. 156. 



IX GREAT BRITAIN. 439 

tinuous Sympathy,' which has kept abdominal surgery in 
comparative abeyance." 

I have thus given more attention to Mr. 
Jeaffreson's case of extirpation of a dropsical 
ovary by the Hunterian short incision than I 
otherwise would have done, because in it he 
claimed originality for the method, just as was 
done in the United States by Dr. Nathan Smith 
and his supporters ; and because the principles 
underlying the practice deserve here to be 
brought out anew in connection with the trial 
of the latter by the other English surgeons 
credited with cases and operations, which finally 
resulted in the revival of the long incision of 
McDowell. 

Mr. King's first and only operation by the 
Hunterian short incision, so far as is known, 
was in an unmarried woman, aged thirty-seven, 
and, the character of the tumor being favorable 
for it, the case terminated in a complete cure 
under the employment of large doses of opium, 
ice-water to the abdomen, and in the rectum as 
well, with tincture of digitalis and nutritive 
enemata. 

Mr. West's case, in which the tumor had also 
been found complicated with a third pregnancy, 
was operated upon with complete success, the 



440 MCDOWELLS OPERA 7 VOX 

operation being performed and the after-treat- 
ment carried out in conformity with the rules 
laid down by Messrs. Jeaffreson and King. His 
second case had an equally favorable ending. 
His third case, Mrs. Tompkins, aged forty, had 
previously been tapped. Hunterian short inci- 
sion employed, as usual. Adhesions found and 
operation abandoned. Patient tapped seven- 
teen times before death terminated the case. 
Who can say that the long incision of [McDowell 
might not have relieved this woman, and given 
her an additional quarter of a century of health 
and happiness ? Mr. West's fourth case was 
similar to the last, the Hunterian short incision 
being used with a like abandonment from adhe- 
sions. Afterward the patient was tapped re- 
peatedly. The same question here likewise 
applies. 

Mr. Hargraves's case, aged forty, presented a 
tumor with distinct fluctuation, but solid portions 
as well were felt through the walls of the ab- 
domen. Hunterian short incision. Adhesions 
found and the operation abandoned, with final 
recovery of patient. This case was wholly un- 
suited for the form of incision employed. The 
long incision of McDowell afforded the only 
chance for removal with certainty and safety ; 



IX GREAT £ RITA IX. 



441 



and why was it not tried when it only needed 
the extension of the short incision in the lower 
division of the abdomen into the region above 
the umbilicus. 

The case in Guy's Hospital, the first operated 
upon in any of the large London Hospitals, 
presented a fluctuating tumor. The Hunterian 
short incision was employed, but the tumor 
could not be reduced in size and drawn 
through the opening. Operation abandoned. 
Patient died, and tumor was found to be 
multilocular, with but slight adhesions. Here, 
who could say that the long incision of 
McDowell would not have given this poor 
woman the requisite chances for the preser- 
vation of her life ? 

Mr. Crisp's case was stated to be of twenty 
years' standing, and she had been tapped 
twice. Hunterian short incision. No adhe- 
sions found, cyst punctured, three gallons of 
fluid drawn off, and the sac removed without 
difficulty. Complete cure. 

Mr. Phillips's case was a young woman. The 
Hunterian short incision employed. No adhe- 
sions found, but the walls of the cyst said to be 
thick. Cyst punctured and drawn through the 
opening. After closure of the wound the 



j 



442 



MC D O WELL'S OPERA TIOX 



patient began almost immediately to complain 
of pain in the right iliac fossa. On the third 
day she was attacked with severe diarrhoea, and 
on the fifth day she died. Autopsy showed 
ligature on pedicle all right, but eight ounces of 
blood in the peritoneal cavity. Here the long 
incision of McDowell would have permitted an 
easy exploration and removal of the cyst, and 
thus have prevented the injury of surround- 
ing structures, the cause, no doubt, of the 
hemorrhage. 

In these ten cases operated upon by the 
Hunterian short incision, all, of course, with a 
view to the more or less simple and fluid char- 
acter of the tumor, the latter was removed in 
six cases, with one death, and was not removed 
in four, with one death and three recoveries, 
the latter cases, however, all terminating fatally 
from the remaining disease, one after seventeen 
tappings, another after repeated tappings, and 
the last after a period not long. Thus is shown 
a success of 60 per cent, and failures in 40 per 
cent., with a mortality of 20 per cent., in cases 
adjudged suitable for the operation, and all by 
surgeons of recognized high ability. 

The question here naturally arose, Why 
should there be so large a proportion of oper- 



IN GREA T BRITAIN. 



443 



ations, in selected cases, unfinished or failures — 
four out of ten? The answer was that, despite 
the best diagnosis possible, the tumors found in 
the four unfinished cases proved too large and 
too much complicated by adhesions to be ex- 
amined, manipulated, and removed through the 
opening in the lower division of the abdomen, 
then deemed sufficiently large. Dr. Charles 
Clay, in England, was the first to make this 
answer, and to rehabilitate, so to speak, the 
McDowell long incision, made in both the lower 
and upper divisions of the abdomen. This he 
did in a case operated upon successfully Sep- 
tember 21, 1842, and as a result of it took place 
the so-called revival of the long incision of the 
" Father of Ovariotomy," which followed a year 
later in the United States, in the hands of Dr. 
John L. Atlee, and soon after in the other two 
countries, France and Germany, where alike, 
as we have seen, his operation has been the 
subject of investigation and defence. 

Following is a general summary of cases 
and results in the United States, Germany, 
and Great Britain, there being no case of 
extirpation of a diseased ovary in France 
during the period under consideration. 



444 MCDOWELL'S OPERATION. 



General Summary of Cases and Results in the 
United States, Germany, and Great Britain. 

united states. 

i 2 completed operations, with 9 cures and 3 deaths. 
6 unfinished " " 6 recoveries. 

Mortality of completed operations, 25 per cent. 

GERMANY. 

1 2 completed operations, with 5 cures and 7 deaths. 
3 unfinished " " 1 recoveryand 2 " 

1 unjustified operation, " 1 " 

Mortality of completed operations, 58.33 per cent. 

great Britain. 

9 completed operations, with 6 cures and 3 deaths. 
8 unfinished " "7 recoveries and 1 death. 

1 unjustified operation, " 1 recovery. 

Mortality of completed operations, 33.33 per cent. 



grand total. 

33 completed operations, with 20 cures and 13 deaths. 
17 unfinished " " 14 recoveries and 3 " 

2 unjustified " " 2 " 

Mortality of completed operations, 39.39 per cent. 



CHAPTER XV. 

EULOGISTIC LETTERS, ETC. 

3 Upper Grosvenor Street, 

London. W., 2d July, 1887. 

Mrs. Mary Y. Ridenbaugh: 

Dear Madam : In reply to your letter of the 
10th of June, I may say that I shall read with 
great interest any life of McDowell that you 
may publish, but I am sorry I cannot add to 
what I have said about him in my book on 
Diseases of the Ovaries 

In 1878 I delivered six lectures at our Col- 
lege of Surgeons, and I concluded those lee- 
tures by some reference to McDowell. 

They were published in the British Medical 
Journal, of July, 1878 (p. 132), and as you 
may have some difficulty in finding them I 
enclose the remarks which I then made, and 
which I can still entirely confirm. 

I am sorry I cannot be of any further assist- 
ance to you. I remain, my dear madam, 
Faithfully yours, 

T. Spencer Wells. 

(445 ) 



446 E 1~ ' L ° G f S TIC L E TTERS, E TC. 



The Remarks of Sir T. Spencer Wells. 1 

The hour is nearly complete, but I cannot conclude 
the very hasty and imperfect review of the subject of 
abdominal tumors, which I have been able to condense 
in six lectures — the operation now accepted as the only 
effectual means of relief in cases of ovarian tumors, espe- 
cially — and of the results which have been obtained in 
alleviating distress and prolonging valuable life, without 
some reference to the man who is justly looked upon as 
"the father of ovariotomy/' 

McDowell was wise, practical, and prophetic. He care- 
fully studied the subject which filled his mind ; did with 
an enviable success what his opportunities permitted ; and 
looked with an anxious eye on the prospect opening up 
to his successors. 

We, more happy in our opportunities, have entered into 
full possession of what to him was little more than a 
promised land; and, speaking personally, I feel it my 
greatest happiness to have been able, chiefly through the 
encouragement of professional brethren (which at one time 
I had- little reason to anticipate), to reach the point at 
which McDowell aimed. 

I have not only attained the amount of operative suc- 
cess which he gave as the standard ; I have not only the 
almost daily gratification of seeing some living and endur- 
ing evidences that my labors have not been in vain ; but I 
have, for the rest of my days, the satisfaction of knowing 
that my example has emboldened others, and will be the 
means of still further extending to human suffering the con- 
solatory assurance of the prospect of relief, and insuring 



1 Delivered at the close of a series of six lectures on the 
" Diagnosis and Surgical Treatment of Abdominal Tumors," 
atthe Royal College of Surgeons of England, June 21, 1878. 



E UL O G IS TIC LE TTERS, £ TC. 



447 



the certainty of its realization by the many skilful hands 
which are now betaking themselves to the work. 

This is a lot which falls to but few innovators. It is not 
given to every one to see the fruit of his labors ; but the 
surest way of gaining that end is by studying the words 
and following the counsel of wisdom. The wish to do 
well what others have done is not all that is wanted. Step 
by step their course must be followed, difficult still, but 
somewhat easier from the results of experience ; and, 
while I content myself with a warning to aspirants that a 
fancied inspiration will not alone carry them on to success, 
I feel that I cannot quit them and the subject better than 
by repeating the words of McDowell, who, though better 
known in the open, rugged field of practice than in the 
paths of literature, was a man of broad and elevated views, 
and thus expressed the advanced opinions he had already 
formed respecting the operation he had inaugurated after 
years of patient waiting and zealous preparation. 

He strove to make ovariotomy a boon to humanity. He 
had reason to believe it had proved so, but he foresaw the 
dangers of its abuse from rash and indiscriminate rivalry 
amongst his followers. Listen to his own words: "I 
think my description of the mode of operating, and of the 
anatomy of the parts concerned, clear enough to enable 
any good anatomist, possessing the judgment requisite for 
a surgeon, to operate with safety. I hope no operator of 
any other description may ever attempt it. It is my most 
ardent wish that this operation may remain to the mechan- 
ical surgeon forever incomprehensible. Such have been 
the bane of the science ; intruding themselves into the 
ranks of the profession with no other qualification but 
boldness in undertaking ; ignorant of their responsibility, 
and indifferent to the lives of their patients, proceeding 
according to the special dictate of some author as mechan- 
ical as themselves, they cut and tear with fearless in- 
difference, utterly incapable of exercising any judgment 
of their own in cases of emergency, and sometimes 



44 8 EULO GIS TIC LE TTERS, E TC. 

without possessing even the slightest knowledge of the 
anatomy of the parts concerned. The preposterous and 
impious attempts of such pretenders can seldom fail to prove 
destructive to the patient and disgraceful to the science. 
It is by such this noble science has been degraded, in the 
minds of many, to the rank of an art." 

In conclusion, allow me to read a sentence or two from 
one of those able reviews which make one regret that the 
day of the medical quarterlies is passed {British and Fo?'eign 
Medical Review, April, 1873): "All honor to McDowell, 
of Kentucky, who, to use the words of Hufeland, 'looked 
upon his profession as a high and holy office, who exercised 
it purely, not for his own advancement, not for his own 
honor, but for the glory of God and the good of his neigh- 
bor, and who, long since called to give an account of it, 
is, no doubt, reaping the reward of his faithful steward- 
ship.'" 



EULO G IS TIC LE TTERS, E TC. 



449 



12 Granville Place, Portman 59, W. 

Mrs. M. Y. Ridenbaugh. 

Dear Madam : I bee to acknowledge the 
receipt of your valued letter of the 12th inst., 
asking me for a contribution to your proposed 
work. While I thank you for the compliment 
you have paid me, I feel that anything I could 
say would only burden your work, and could 
not add to the renown attaching to the name 
of Ephraim McDowell. 

I shall look forward with much anticipation 
to the reading of the biography of so remark- 
able a man, who was so far in advance of his 
age, whose originality and surgical skill are 
still so conspicuous, and whose name is insepar- 
ably linked with the greatest surgical achieve- 
ment of this or any other age. 

Hoping that a grand success will crown 
your noble efforts, I have the honor to be, 
dear madam, 

Yours very faithfully, 

George Granville Bantock. 



29 



j 



450 eulogistic letters, etc. 

Correspondence between Professor Alexander 

Russell Simpson, Dr. Willoughby Walling, 

and the Authoress, 

Relative to a Lecture delivered by Professor Simpson at the 
University of Edinburgh, Scotland, October 19, 1887. 1 

52 Queen Street, Edinburgh, Scotland, 
October 20, 1887. 

Dr. Willoughby Walling. 

My dear Sir : My introductory lecture, 
which contains, I believe, everything that can 
be gleaned from reference to our University 
matriculation books regarding Ephraim Mc- 
Dowell, will be published soon in one of our 
medical journals, 2 of which I shall be glad to 
send a copy to Mrs. Ridenbaugh. 

Yours very faithfully, 

A. R. Simpson. 

The above note was in reply to a letter to 
Professor Simpson from Dr. Willoughby Wall- 
in £, United States Consul for Leith, who writes 
from Edinburgh to the authoress of this work, 
as follows : 

1 Part of an introductory lecture on the Ninth International 
Medical Congress and American Gynecology. 

2 Published in the British Medical Journal, London, July 2, 
1887, vol. ii. p. 977. 



E VL O GIS TIC LE TTERS, E TC. 



451 



U. S. Consulate for Leith, Edinburgh, Oct. 20, 1887. 

Mrs. Ridenbaugh. 

Dear Madam : .... You will see from 
the enclosed card from Professor A. R. Simp- 
son that I am in a way to get what you want. 
I will, however, be compelled to wait until the 
publication of the lecture referred to in the 
communication of Professor Simpson. 

.... I want to suggest that if you have 
not gotten a speech made by Dr. R. O. Cowl- 
ing, 1 at Danville, Kentucky, about the year 1879, 
at the meeting of the Kentucky State Medical 
Society, the occasion being the presentation of 
the door-knocker of Dr. McDowell's old resi- 
dence to Dr. S. D. Gross, of Philadelphia, you 
should by all means have it. 

Dr. Cowling was an old friend of mine, a 
professor of surgery in the University of Louis- 
ville, Ky., and the speech referred to was one of 
the most eloquent I ever heard, and was equally 
laudatory of Dr. McDowell and Dr. Gross. 

So strong was it that when Dr. Gross arose 
to reply he was so overcome by emotion that 
he could not speak for some moments. . . . 
Very respectfully, 

WlLLOUGHBY WaLLING. 
1 See page 553. 



452 



EULOGISTIC LETTERS, ETC. 



52 Queen St., Edinburgh, Dec. 6th, 1887. 



Mrs. Mary Y. Ridenbaugh. 

Dear Madam : At the commencement of our 
session I gave a brief sketch of the work of 
Dr. Ephraim McDowell. . . . 

I send you now along with this a separate 
copy of the lectures, as I have got some printed 
for distribution among - the students. . . . 

McDowell was a hero of whom our profes- 
sion may well be proud, and a good biography 
of him will receive a wide welcome. . . . 

Believe me, 

Yours very faithfully, 

A. R. Simpson. 



PROFESSOR ALEXANDER RUSSELL SIMPSON'S 
LECTURE. 

I have said that the Transactions of the American 
Gynecological Association give evidence of the vast 
amount of earnest and faithful work that is wrought in 
our department by our trans-Atlantic confraternity. And 
I would add that the noble services they have rendered 
in the past are an inspiration and incentive to them and 
us to further achievement in the future. 

Have you ever thought how much obstetrics and gyne- 
cology owe to America? We sometimes hear half con- 
temptuous reference to the scream of the American eagle; 
but, in our section of medicine, at least, she has established 
the strongest claims to let her voice be heard. 



E UL OGIS TIC L E TTERS, E TC. 



453 



I cannot pretend just now even to give an inventory 
of the contributions that have travelled to us over the 
Atlantic waters, but let me indicate a few. 

Laparotomy. — First of all, we must acknowledge Amer- 
ica's just claim to be the birthplace of ovariotomy. The 
conception was not peculiarly American. It had been 
thought of elsewhere. It had been talked of and written 
about, but only to be talked down and written down. It 
had even been attempted, but usually only in a doubtful 
and tentative sort of way, in isolated and unsuccessful 
cases. 

In 1809, at Danville, in Kentucky, a practitioner who 
had already achieved a surgical reputation for success in 
lithotomy and hernia — numbering among his thirty-two 
lithotomies (all successful) an operation on young James 
K. Polk, who afterward became President of the United 
States — removed an ovarian cystoma. The patient recov- 
ered. Four years later he repeated the operation on an- 
other patient with successful result. After the lapse of two 
more years he for the third time saved a life by extir- 
pating an ovarian tumor. 

He did not publish his cases until 181 7, and then in a 
somewhat slipshod fashion in an American journal. He 
sent a copy of his paper to his old teacher, J hn Bell, of 
Edinburgh. John Bell was ill at the time, and away on 
on the Continent in quest of health. The paper fell into 
the hands of John Lizars, who was doing duty in the ab- 
sence of his friend. Stimulated by the perusal, Lizars 
opened an abdomen where he and some of the other 
Edinburgh surgeons and obstetricians believed the pa- 
tient to be the subject of an ovarian tumor. 

He seems to have supposed that the American's success 
was in some measure due to climatic conditions, from this 
sentence, "As inflammation appears to be generally in- 
duced by exposure to cold, and, as these cases succeeded 
so well in America, I desired the room to be heated to 
8o° F." The diagnosis proved to be wrong, but the 



454 



E UL OGIS TIC L E TTERS, E TC. 



patient recovered, and Lizars republished in the Edinburgh 
Medical Journal, for October, 1824, the cases of the more- 
successful American surgeon, prefixing a brief historical 
notice of the operation, and appending the history of his 
own case. 

How this first public announcement of the splendid 
achievement was received in England let the editor of the 
London Medico- Chirurgical Review, writing a notice of 
Mr. Lizars' s paper, reveal to us : 

" Passing over the records of surgery, all of which can- 
not be depended on, we shall come at once to the recent 
facts, or alleged facts, communicated in this paper by Mr. 
Lizars. Three cases of ovarian extirpation occurred, it 
would seem, some years ago in the practice of Dr. Mac- 
dowal, of Kentucky, which were transmitted to the late 
John Bell, and fell into the hands of Mr. Lizars. We 
candidly confess that we are rather sceptical respecting 
these statements, and we are rather surprised that Mr. 
Lizars himself should put implicit confidence in them. A 
woman, supposed to be parturient, was visited by Dr. 
Macdowal at the instigation of two physicians who con- 
sidered her in the last stage of pregnancy. Dr. Macdowal 
found the u'erus unimpregnated, but a large tumor in the 
abdomen movable from side to side. The woman travelled 
sixty miles on horseback to have an operation performed. 
Dr. Mac made an incision, nine inches in length, parallel 
with the rectus abdominis, and right into the abdominal 
cavity. The tumor appeared in view, but could not be 
removed. A ligature was thrown round the Fallopian 
tube, the tumor cut open (found to be the ovarium) and 
fifteen pints of dirty gelatinous stuff extracted, 'after 
which we cut through the Fallopian tube and extracted the 
sac, which weighed seven pounds and a half.' As soon as 
the external opening was made the intestines rushed out 
upon the table, and they could not be replaced till after 
the operation was performed, which lasted twenty-five 
minutes ! The wound was sewed up by means of the inter- 



E UL O GIS TIC LE TTERS, ETC. 455 

j 
rupted suture, assisted by means of adhesive plaster. Dr. / 

Mac visited the patient at the end of five days, though she 

had come to his own residence to have the operation per-\ 

formed ! ! He found her engaged in making her bed !/ 

She soon returned to her native place quite well. Credai 

Judceus, non ego. 

" The second case is little less extraordinary, if not 
incredible. A negress had a hard, painful, fixed tumor in 
the abdomen. Dr. Mac placed her on a table, laid the 
abdomen open, inserted his hand, and found the ovaria 
very much enlarged, painful to the touch, and firmly ad- 
hering to the bladder and fundus uteri. To extract this 
(two ovaria) he thought would be instantly fatal ; 'but, 
by way of experiment,' says the doctor, 'I plunged the 
scalpel into the diseased part, when some gelatinous sub- 
stance, as in the above case, with a profusion of blood, 
rushed to the external opening, which I conveyed off by 
placing my hand under the tumor and suffering the dis- 
charge to run over it.' A quart or more of blood escaped 
into the abdomen. The same dressing and the same 
success as in the first case. \Xe_xanmpt bjingjourselves to 
credittfiis statement. ' ' 

The same Review writer in April, 1825, has still, no 
doubt, the Kentucky operator (McDowell) in his mind 
when he falls foul of the great obstetrician, Dr. Blundell, 
for thinking that ovariotomy will ultimately come into 
general use, and saying: "If the British surgeons will 
not patronize and perform it, the French and American 
surgeons will;" for he adds: "In despite of all that 
has been written respecting this cruel operation we entirely 
disbelieve that it has ever been performed with success — 
nor do we think it ever will." 

How hard it is to move a man who has committed him- 
self to the position of a sceptic may be seen from the 
manner in which this writer returns to the subject in Octo- 
ber, 1826, after the North American Medical and Surgi- 
cal Journal 'had come into his office to tell him that "Dr. 
Mar," as he contemptuously called the ovariotomist, had 



456 EULO GIS TIC L E TTERS, E TC. 

operated not only three but five times, and in four of 
the cases with success. 

" Extirpation of an Ovarium. — A back settlement of 
America — Kentucky — has beaten the mother country, nay, 
Europe itself, with all the boasted surgeons thereof, in the 
fearful and formidable operation of gastrotomy, with ex- 
traction of diseased ovaria. In the second volume of this 
series, page 216, we adverted to the cases of Dr. Macdowal, 
of Kentucky, published by Mr. Lizars, of Edinburgh, and 
expressed ourselves as sceptical respecting their authen- 
ticity. Dr. Coates, however, has now given us much more 
cause for wonder at the success of Dr. Macdowal ; for it 
appears that out of five cases operated on in Kentucky by 
Dr. M., four recovered after the extraction, and only one 
died. There were circumstances in the narratives of some 
( of the first three cases that raised misgivings in our minds, 
for which uncharitableness we ask pardon of God, and of 
Dr. Macdowal, of Danville. The two additional cases 
now republished (for it appears that the cases were pub- 
lished, though in a very unsatisfactory form, in the Ameri- 
can Eclectic Repertory^) are equally wonderful as those 
with which our readers are already acquainted." And 
toward the close of the article he says: " It was this mode 
of narration that excited our scepticism, and we must con- 
fess it is not yet removed." 

Now the man whose splendid success in a new field was 
received with so much scorn and scepticism, not only on 
this side of the ocean but his own, was no haphazard 
adventurer out in the wild West. 

Born in Virginia in 1771, and moved with his father's 
household to Kentucky in 1782, where his father became 
judge of the district court, he seems to have had but 
an imperfect training in letters in a land that, during his 
childhood, was fighting its way to freedom. After leaving 
school he studied medicine with Dr. Humphreys, of Staun- 
ton, Virginia, a graduate of the University of Edinburgh. 
Philadelphia was then the only seat of medical education 
in the United States, and doubtless it was at the instance 



EULO GIS TIC L E TTERS, E TC. 



457 



of this Edinburgh alumnus, with whom he had been read- 
ing from two to three years, that the eager student crossed 
the deep, and came to enroll himself among the Cives 
Academiae Edinensis. 

In the roll of Session 1792-93 I find that Ephraim Mc- 
Dowell has inscribed his name as it is reproduced in the 
zincotype (see frontispiece). It was not then the custom 
for the entrant to give his place of birth and residence. 
So he has simply signed his name, and opposite the sig- 
nature the secretary has noted that he is entered to study 
chemistry. 

In that subject he would come under the inspiring in- 
fluence of Joseph Black, and, as he had no other university 
class that session, it was probably during it that he studied 
surgery with John Bell. In a biographical sketch of him 
by the late Professor Gross, of Philadelphia, it is stated very 
confidently that it was during his second year that he 
attended the lectures of that distinguished extra-mural 
teacher. But, when he matriculates for the second time, 
at the beginning of session 1793-94, he is entered for the 
classes of anatomy and surgery under the second Monro; 
practice of medicine under James Gregory ; and botany 
under Daniel Rutherford ; besides the clinical prelections 
in the Royal Infirmary. 

With so much to do in his second session, and so little 
in the first within the university, it seems to me more 
probable that he had put himself under Bell's tuition dur- 
ing his first session here. 

Our librarian has shown me the library day-book of the 
time, from which it appears that throughout he had been 
greatly interested in the study of chemistry. On February 
25, 1793, he had out Hopson's Chemistry ; on March nth, 
Hoffman's Practice of Medicine ; March 25th, Chaptal's 
Chemistry; April 8th, vol. ii. of the same work, and on 
April 27th, Hamilton on Female Complaints. 

During the summer he had ceased to borrow from the 
library, and he then may have been making the excursion 
through Scotland, described by Gross, in company with 



458 



E UL O GIS TIC LE TTERS, E TC. 



two of his compatriots, one of whom had been his fellow 
apprentice with Dr. Humphry's, of Staunton, and who 
enrolled himself in the same two sessions with McDowell 
as Sam Brown. 

On September 25th a friend, James Cairns, a matriculate 
of 1793-94, gets Fourcroy's Chemistry for him; on Octo- 
ber 3d he is at the library himself for Savary's Letters on 
Egypt ; on October 15th he gets a volume of Chemical 
Theses and two volumes of Medical Commentaries, and the 
last entry is on October 29th, 1793, wn ^n his friend Cairns 
gets for him Cullen's Practice of Physic. 

Among the readers who must have rubbed shoulders with 
him at the librarian's table were Henry Brougham and 
Francis Horner ; among the students who sat in the same 
classes with him were Monro Tertius, (Sir) William New- 
bigging, and John Bell's youngest brother, (Sir) Charles. 

Members of the athletic club will be pleased to hear, from 
Dr. Gross, that he used often to narrate with special glee 
how, during his sojourn in Edinburgh, "a. celebrated Irish 
foot-racer arrived, boasting that he could outrun, outhop, 
and outjump any man in the city, and bantered the whole 
medical class. McDowell was selected as their champion. 
The distance was sixty yards, and the stake ten guineas. 
The trial took place in the coUege grounds, and the Amer- 
ican allowed himself purposely to be the loser. A second 
race for one hundred guineas and at an increased distance 
came off soon afterward, and this time the Irishman, after 
much bullying, was badly beaten, much to his own chagrin 
and the gratification of the students." That by way of 
parenthesis to help you know the man. 

Gross is uncertain as to whether he graduated here or not. 
But clearly he had not taken out the requisite courses to 
qualify, and his name is not to be found in our roll of 
graduates. 

Doubtless his biographer is correct in thinking that the 
teacher from whom he learned the most was John Bell, 
whose " enthusiasm and ardor," says Gross, "were abso- 
lutely boundless." 



EULO GIS TIC LE TTERS, E TC. 



459 



It is difficult to conceive, at this distant day, the charm 
which this great teacher infused into his subjects and 
the ambition which he inspired in his pupils. All loved 
him ; many worshipped him ; not a few idolized him. 
Among the latter was the subject of this memoir. 

During his attendance upon his prelections the young 
American was enraptured by the eloquence of his teacher, 
and the lessons which he imbibed, while thus occupied, were 
not lost upon him after his return to his native country. 

Mr. Bell is said to have dwelt with peculiar force and 
pathos upon the organic diseases of the ovaries, speaking 
of their hopeless character, when left to themselves, and of 
the possibility, nay practicability, of removing them by 
operation. The instruction thus given made a powerful 
impression upon Dr. McDowell, which was not lost upon 
him after he took leave of the academic groves of Edin- 
burgh. 

What actual success McDowell on the whole achieved is 
not accurately known. It is said he operated thirteen 
times in all with eight recoveries. It would seem, there- 
fore, that he was not so happy in his later series of cases as 
he had been in his earlier. But, it was a splendid triumph, 
then, to have rescued eight women from inevitable death, 
and, whatever premonitions of it there may have been 
beforehand, America has the right to claim for Ephraim 
McDowell the foremost place among ovariotomists. 

As Prof. Parvin said : " The suggestions of Hunter and 
the instructions of Bell had an important influence upon 
McDowell's mind, but this detracts nothing from the glory 
of his achievement. The fame of Columbus is not dimmed 
by the fact that others before him, others in his time, be- 
lieved with him that by sailing westward a sea-way to the 
Indies would be found. No matter what surgeons may have 
believed and suggested as to removal of diseased ovaries, 
no matter though John Bell taught the mode of operating, 
their faith without works was utterly dead, and the new 
Columbus (McDowell) started upon his exploration without 
pilot or chart." 



460 EULOGIS TIC L E TTEES, E TC. 



Response of Professor D. W. Yandell, 
of Louisville, Ky., 

In behalf of the invited guests, at a Complimentary Dinner to 
Professor Samuel D. Gross. 1 

Mr. Chairman : When the invitation came to unite in 
this offering, I was deeply touched. It revived memories 
of my student life, when, as a pupil of your guest, I came 
before him for examination for the doctorate, now thirty- 
three years — a generation — ago. The teachings of that 
period have remained a part of my life. The method, 
the system, which the great master observed, as in his 
earnest way he gradually unfolded to the minds of his 
hearers the grand truths which lie in the upper planes of 
surgery ; the painstaking, conscientious care with which he 
infused interest into the dry details of his subject, his fiery 
zeal, his never-flagging industry, and, better than all this, 
the solemnity with which he declared that to be a truly great 
physician it was essential to be at the same time a truly 
good man — all these are as fresh to me this evening as 
when I made one of his hearers, now so long ago. 

Mr. Chairman, I obeyed the summons to be here with 
alacrity. I came with pleasure. Nay, more, I came with 
feelings akin, I fancy, to those which animate the pilgrim 
as he turns his footsteps toward the tomb of the Prophet. 

With fitting reverence, sir, I stand in this august pres- 
ence. I come, sir, as the humble representative of a great 
people, the people of Kentucky, who send you greeting 
on this auspicous occasion. I come, empowered by them 
to lay at the feet of your illustrious guest the homage of 
that renowned commonwealth. I come to wish him yet 
many years upon the earth, and to say that, though his 
name and fame have become a common heritage, Ken- 

1 Given by his medical friends in commemoration of his 
fifty-first year in the profession. April 10, 1879. 



EULO GIS TIC L E TTERS, E TC. 46 x 

tucky still claims them as peculiarly her own, since it was 
in her borders that he laid the foundation of a reputation 
which has not only irradiated this continent, but has 
penetrated wherever civilization is known or surgery is cul- 
tivated as a science. 

I feel, Mr. Chairman, that it is an honor to be called on 
to speak on such an occasion and for such a people — a 
people that has given to statesmanship a Clay, a Lincoln, 
and a Breckenridge ; to arms a Johnston, a Preston, and 
a Buckner ; and to surgery a McDowell and a Dudley. A 
goodly company ! Stately names ! Would you think me 
as exceeding the limits of good taste if I added — and 
chief among all these is that of him who bears the mark 
of our guild — Ephraim McDowell? 

For, sir, will not the labors of the statesman yield to 
the pitiless logic of events ; the voice of the orator grow 
fainter in the coming ages ; and the deeds of the soldier 
eventually find place but in the libraries of the student of 
military campaigns ; while the achievements of the village 
surgeon (McDowell) like the widening waves of the inviolate 
sea, shall reach the uttermost shores of time, hailed of all 
civilizations as having lessened the sufferings and length- 
ened the span of human life ? 

Again, would you think me very far wrong were I to 
couple the victorious issue of the late war, and the opera- 
tion of ovariotomy as, in different fields, the two most 
stupendous events of modern times? 

Sir, both are to be credited to Kentuckians. Mr. Lin- 
coln effected the one. Dr. Ephraim McDowell accom- 
plished the other. 

Nor yet, in my opinion, do the two achievements admit 
of comparison. Powerful cabinets, far-seeing ministers, 
renowned captains, a daring and multitudinous soldiery, a 
rich, a steady, a united, and a persistent people contributed 
to the success of the former. Its glory was won amid the 
blare of trumpets, the groans of men, the shock of contend- 
ing armies. The glory of the other belongs to but one 



462 



E UL OGIS TIC LE TTER S, E TC. 



man, is single and indivisible, was born under the eyes of 
fair women, and by the cunning of a single hand, which, 
amid supreme peril, plucked victory from an enemy that, 
before McDowell's time, had defied all that was subtlest in 
art, and repulsed every assault of science. 

But, sir, I fain must have done. I feel that it is good to 
have been here. I shall return to my people and recount 
to them what I have seen and what heard, and repeat to 
them what I now offer in their name : 

'•'To our guest, the illustrious son of Pennsylvania, the 
foster son of Kentucky, who, to the nimbus which ever 
encircles great deeds, has added the milk-white flower of a 
stainless life." 



E UL O GIS TIC LE TTEES, E TC. 



463 



St. Louis, Mo., May, 1889. 

Mrs Mary Y. Ridenbaugh. 

My dear Madam : I regret very much that 
unavoidable circumstances prevented me from 
calling upon you personally before you left the 
city, thus enabling me to form a more correct 
idea of the scope of the memoir which you are 
preparing of your distinguished ancestor, Dr. 
Ephraim McDowell. 

You request me to make some contribution 
to your work, forgetting, perhaps, that not 
knowing what others have written, I may follow 
too nearly in their footsteps to present anything 
worthy of being considered original or readable. 

For, I feel that I would be unable to add a 
single leaf to the garland of honor and glory 
which an enlightened and grateful profession 
have already woven around the name and 
memory of your distinguished grandfather. 

So long as the fame of Sir Isaac Newton is 
cherished among philosophers, or that of Chris- 
topher Columbus is held in reverence by navi- 
gators, will the lesson of the life and achieve- 
ments of McDowell receive respectful homage 
at the hands of surgeons throughout the entire 
world. And could the women of the present 



464 EULO GIS TIC L E TTEES, E EC. 

generation fully realize the blessings which have 
accrued to their sex through the seeds planted 
by the patient industry of this great physician, 
they would erect above his grave a monument 
far eclipsing the proudest of the Pyramids. 

But, it is not in the line of eulogy that I would 
speak of Dr. Ephraim McDowell, for he needs 
none. 

The practical lesson of his professional life is 
to me the chief object of interest and study, 
since it carries with it a moral of peculiar value 
to the younger members of the medical profes- 
sion. Although he had the best advantages 
of study which his times and generation afforded, 
yet his sources of information were limited as 
compared with the superior resources accessible 
to the student of the present day. 

He evidently possessed, however, a well- 
trained and analytical mind which enabled him 
to turn to the best account such opportunities 
as came in his way. He cultivated inde- 
pendence of thought and action. What he 
learned he learned well ; so well, that it proved 
a deep and abiding foundation upon which he 
could venture to build. To a natural courage 
was added that self-reliance which is born of 
mature knowledge and clear perception. He 






EULO GIS TIC L E TTERS, E TC. 



465 



was evidently a close and practical student of 
those fundamental principles of medicine, anat- 
omy, physiology, and pathology. The surgical 
triumph which in due time rendered his name 
famous followed naturally. 

Galileo was not the first to suggest the tele- 
scope, neither was McDowell the first to sug- 
gest ovariotomy, and yet their names will be 
handed down to future ages as indissolubly 
connected with two of the crowning triumphs 
of science, What the one did for astronomy 
the other accomplished for abdominal surgery. 
Each developed and crystallized into practical 
results what before were merely theories, or 
vague ideas. 

It is difficult for the laymen, who is ignorant 
of the anatomical relations and pathological 
conditions peculiar to the several varieties of 
ovarian tumors, to fully appreciate the brill- 
iancy of McDowell's achievement. It is only 
the anatomist and the pathologist who, in the 
light of knowledge, can enter fully into the 
spirit which animated this bold pioneer as he 
ventured into a hitherto unexplored region of 
surgery, with rude instruments and with no 
precedents to guide him. 

It is plain that he had pondered well over 



466 EULOGISTIC LETTERS, ETC. 

the prophetic suggestions of the great Hunter, 
and of his illustrious preceptor, John Bell, of 
Edinburgh. In this instance Hunter may have 
planted, and Bell watered, but it was McDowell 
whose intelligent and unerring hand plucked 
the practical fruit of victory. 

After careful dissections and patient investi- 
gation at the bed-side and in the dead house, 
he arrived at a matured and intelligent plan of 
procedure, which for the first time placed the 
operation of ovariotomy upon a scientific basis. 

However brilliant may have been the im- 
provements which have attended later efforts 
in this direction, it will be impossible to efface 
the debt of gratitude due to the courage and 
skill manifested in the conception and execution 
of Ephraim McDowell. 

Trusting that you may meet with success in 

your very laudable undertaking I am, with 

respect, 

Very truly yours, 

Walter Coles, M.D. 




THe M«do\x/eLL lYiofviiJiVfENT- 



DANVILLE, KY. 



:-Vi 



CHAPTER XVI. 

memorial services at the unveiling of 
the Mcdowell monument. 



This chapter is made up from a volume en- 
titled ''Memorial Oration in Honor of Ephraim 
McDowell, the * Father of Ovariotomy,'" pub- 
lished by the Kentucky State Medical Society, 
Louisville, 1879. 

That Dr. Ephraim McDowell, of Danville, 
Ky., was the first to perform the operation of 
ovariotomy, and by his successful cases make 
the extirpation of diseased ovaria a legitimate 
surgical procedure, has long been conceded 
both in this country and in Europe. To Dr. 
S. D. Gross, of Philadelphia, is due the credit 
of successfully establishing the claims of Mc- 
Dowell to priority in this important field of 
surgery. 

The idea of marking the last resting-place of 
the first ovariotomist with some memorial com- 
memorative of his great services to humanity 
originated with the late Dr. John D. Jackson, 

(467) 



4 58 MEMORIAL SERVICES. 

of Danville, and was brought by him to the 
attention of the Kentucky State Medical 
Society, and from thence before the American 
Medical Association. Quite a number of sub- 
scriptions were made to this object by members 
of the National Association, but at the meeting 
in Louisville, in 1875, tne Association adopted 
a resolution creating a Prize-essay Fund for 
the perpetuation of McDowell's great achieve- 
ment. The resolution left to the profession of 
Kentucky the work of placing some local 
memorial over his grave. The death of Dr. 
Jackson occurring soon afterward, the Ken- 
tucky State Medical Society intrusted the work 
to Dr. Lewis S. McMurtry, of Danville, the 
pupil and friend of Dr. Jackson. To his 
energy and perseverance, under many dis- 
couraging circumstances, the complete and 
perfect success of the enterprise is attribut- 
able. In addition to those made by the mem- 
bers of the Kentucky State Medical Society 
subscriptions toward the erection of a monu- 
ment to McDowell were made by Dr. Lewis A. 
Sayre, of New York, Dr. Samuel D. Gross and 
the late Dr. Washington L. Atlee, of Philadel- 
phia, the late Dr. Edmund R. Peaslee, of New 
York, and Dr. J. A. Murphy, of Cincinnati. 



MEMORIAL SERVICES. 

The monument is a handsome shaft made 
from Virginia granite. Midway on the shaft 
is a bronze medallion of McDowell, and be- 
neath the medallion his monogram with the 
motto, " Honor to whom honor is due." Upon 
the front face of the monument is the following 
inscription, encircled with a laurel wreath : "A 
grateful profession reveres his memory and 
treasures his example." On the opposite side 
is inscribed, "Erected by the Kentucky State 
Medical Society, 1879." On the eastern face 
this inscription : " Beneath this shaft rests 
Ephraim McDowell, M.D., the 'Father of 
Ovariotomy,' who, by originating a great sur- 
gical operation, became a benefactor of his 
race, known and honored throughout the 
civilized world.'' The western face is devoted 
to the historic inscriptions as follows, being 
encircled with the ^Esculapian serpent : " Born 
in Rockbridge County, Virginia, 1 77 1 ; attended 
the University of Edinburgh, 1 793 ; located in 
Danville, Ky., 1795 ; performed the first ovari- 
otomy 1809 ; died 1830." The monument is 
beautifully located near the centre of the city of 
Danville, in a park of several acres, which, by 
subscription of the citizens of that place, has 
been beautified and made suitable for the 
purpose. 



4 -o MEMORIAL SERVICES. 

The dedication of the monument occurred on 
the 14th of May, during the session of the 
Kentucky State Medical Society at Danville. 
These services, were unusually interesting and 
and imposing. An immense audience composed 
of the members of the Society, and of ladies 
and gentlemen from all parts of the State, 
assembled to witness them, and to honor the 
memory of a great man. In addition to the 
members of the Society, the Governor, the 
Secretary of State, the speakers of the two 
houses, and other officials, the following well- 
known physicians and surgeons of other States 
occupied seats on the platform : Dr. Gilman 
Kimball, Lowell, Mass. (who has performed 
ovariotomy two hundred and thirty-nine times) ; 
Drs. Whittaker, Seely, Ayres, and Stevens, of 
Cincinnati ; and Dr. McDowell, of St. Louis, 
and Drs. V. P. Gibney and Lewis A. Sayre, 
of New York City. 

The committee regrets exceedingly that a 
letter addressed it by Dr. Fordyce Barker, 
President of the New York Academy of Medi- 
cine, failed to reach its destination. 

Coleman Rogers, 
Preston B. Scott, 
J. W. Holland, 

Committee of Publication. 



MEMORIAL SERVICES. 471 

Louisville, Ky () May 17, 1879. 

Dr. L. S. McMurtry, 

Chairman McDowell Monument Committee, Danville. 

Dear Sir: In accordance with the resolution 
adopted by the Kentucky State Medical So- 
ciety on the 15th of May, I would respectfully 
request you to forward me for publication the 
Proceedings of the McDowell Memorial Exer- 
cises, held in your city on the 14th instant. 
I am, very respectfully, 

Coleman Rogers, 

Chairman Committee of Publication. 



Danville, Ky., June 19, 1879. 

Dr. Coleman Rogers, 

Chairman of the Committee of Publication, Louisville. 

Dear Sir : I have the honor to send herewith 
the Proceedings connected with the Dedication 
of the McDowell Monument, as requested in 
your favor of the 17th instant. 

I am, yours, etc., 

L. S. McMurtry, 

Chairman McDowell Monument Committee. 



DEDICATORY ADDRESS. 

By PROF. SAMUEL D. GROSS, M.D. 

Gentlemen of the Kentucky State Medi- 
cal Society, Ladies and Gentlemen: Nearly 
fifty years ago the citizens of Danville, then 
a small, obscure village, carried to its last 
resting-place all that was mortal of the man 
whose monument will henceforth mark an era 
in the history of the medical profession and 
of the people of Kentucky. The announce- 
ment of his death, after a brief illness, in the 
fifty-ninth year of his age, on the 20th of June, 
1830, caused deep and wide-spread grief in the 
community in which he had so long lived, and 
of which he had been so conspicuous, honored, 
and beloved a member. By none was his loss 
more profoundly deplored than by the poor of 
Danville and its neighborhood, who had been 
so frequently benefited by his skill and so fre- 
quently the recipients of his bounty. Many a 
tear was shed as the body was tenderly laid in 

the earth, and many a sigh was heaved as the 

(472) 



DEDICA TOR Y ADDRESS. 



473 



reflection came that the mantle of such a man 
would be long in finding worthy shoulders. Of 
those who were present on that melancholy 
occasion, one after another has disappeared. 
New generations have sprung up, and a scene 
that wrapped a whole community in sorrow and 
caused general regret in the American medical 
profession is with most of the people of this 
section of Kentucky a mere tradition. The 
marble slab erected by the hand of affection 
over the mortal remains bears the simple but 
significant inscription, Ephraim McDowell. 

Who was this man, this Ephraim McDowell, 
in honor of whose memory we have assembled 
here this evening ? Was he a hero whose body 
was scarred as he was leading his armies in the 
defence of his country? Was he a great magis- 
trate, meting out justice to his fellow-citizens, 
protecting their rights, and wisely interpreting 
their laws ? Was he a legislator, devising 
means for the development of the resources of 
his state, and the promotion of the happiness 
of society ? Was he a great senator, like Clay, 
or Crittenden, or Webster, expounding the 
constitution and convulsing the American 
people by the power and majesty of his 
eloquence ? Ephraim McDowell was not any 



474 MEMORIAL SERVICES. 

of these, and yet he was none the less a good 
and a wise man, nor is he any the less entitled 
to the world's gratitude. Following the noble 
vocation of a practitioner of the healing art, 
liberally dispensing alike to poor and rich the 
blessings of his knowledge and of his skill, he 
silently pursued the even tenor of his way, a 
faithful servant of his profession, with no am- 
bition for meretricious distinction. It was here, 
on this very spot, that he achieved that renown 
which so justly entitles him to be ranked among 
the benefactors of his race. It was here, while 
engaged in the daily routine of his calling, that 
he performed an exploit which no one had ever 
achieved before, and which, although for a long 
time denounced and condemned by many other- 
wise enlightened surgeons and practitioners as 
an outrageous, if not murderous, innovation, is 
now universally admitted as one of the estab- 
lished procedures in surgery ; an operation 
which, in its aggregate results in the hands of 
different surgeons, has already added upwards 
of forty thousand years to woman's life, and 
which is destined, as time rolls on, to rescue 
thousands upon thousands of human beings 
from premature destruction. 

Ephraim McDowell will be regarded in all 



DEDICA TOR Y ADDRESS. 



47S 



time to come as the "Father of Ovariotomy," 
and as one of the master spirits of his profes- 
sion. We are here this evening to place upon 
his tomb a wreath of immortelles expressive of 
our admiration and respect, and of the grati- 
tude of more than two thousand women rescued 
from an untimely grave by his operation. That 
his claims to this distinction are well founded 
the history of this operation abundantly attests. 
For a long time it was thought that other sur- 
geons had anticipated him in this undertaking, 
but all the doubt that had hung over the sub- 
ject was at length completely dispelled in 1852 
in an address which I had the honor to read 
before the Kentucky State Medical Society at 
its annual meeting at Louisville, entitled "A 
Report on Kentucky Surgery." In the prose- 
cution of my inquiries I became deeply inte- 
rested in the subject of ovariotomy, and espe- 
cially in the claims of McDowell as its origi- 
nator. With this end in view I engaged in a 
long and laborious correspondence, in which I 
was kindly assisted by Professor Daniel Drake, 
Dr. William Gait, and Dr. William A. Mc- 
Dowell, a nephew and at one time a partner 
of the great surgeon. Letters were addressed 
to physicians in different parts of the State, and 



476 MEMORIAL SERVICES. 

also to the surviving members of Dr. Mc- 
Dowell's family, asking for information re- 
specting the number and results of his cases, 
as well as the names and residences of his 
patients, and any other intelligence calculated 
to throw light upon his life and character; 
matters concerning which, up to that period, 
hardly anything definite was known. These 
documents are still in my possession, and will 
probably at no distant day be given to the 
public. 

When this investigation was begun the 
origin of this operation was generally ascribed 
to a French surgeon, L'Aumonier, of Rouen, 
who, it was contended, had performed it in 
1776, when McDowell was hardly five years 
old. More recently the honor has been claimed 
by our British brethren for Dr. Robert Hous- 
ton, of Glasgow, whose name appears in con- 
nection with an operation upon the ovary as 
early as 1 77 1 . The operation, however, has 
been found upon a careful examination of the 
history of the case to be entirely different from 
that of the Kentucky surgeon. The case was 
simply one of ovarian tumor, the contents of 
which were partially evacuated by an incision 
made through the abdomen, the cyst itself 
being left behind. 



DEDICA TOR Y ADDRESS. 477 

These and other pretensions that have been 
set up by different nationalities are wholly un- 
supported by facts ; for a careful study of the 
cases which have been reported by their respec- 
tive operators will serve to convince any un- 
prejudiced mind that, so far from being exam- 
ples of ovariotomy, they were simply instances 
of cystic tumors, similar to those already men- 
tioned in connection with the names of L'Aumo- 
nier and Houston. Indeed a considerable 
number of such operations were performed 
during the last century, chiefly by French, Ger- 
man, and English surgeons, or, as they would 
now call themselves, if living, gynecologists. 

The first actual case of ovariotomy of which 
there is any authentic account occurred in this 
town in December, 1809, in the hands of Dr. 
Ephraim McDowell, and to him and to him 
alone is due the credit of having devised and 
first successfully executed the operation. All 
honor, then, we say, to the man who thus paved 
the way to a new path of humanity, since so 
nobly trodden by his successors ! All honor to 
the man who had the courage and skill to do 
that which no man had ever dared to do be- 
fore ! All honor, too, to the heroic woman 
who, with death literally staring her in the face, 



478 



MEMORIAL SERVICES. 



was the first to submit calmly and resignedly to 
what certainly was at the time a surgical ex- 
periment. To her, too, let a monument be 
erected, not by the Kentucky State Medical 
Society or by the citizens of Kentucky, but by 
suffering women who, with her example before 
them, have been the recipients of the inestimable 
boon of ovariotomy, with a new lease of their 
lives and with immunity from subsequent dis- 
comfort and distress. I know of no greater 
example in all history of heroism than that dis- 
played by this noble woman in submitting to an 
untried operation. McDowell himself must 
have been startled, if not absolutely abashed, 
when he found how willing she was, after he 
had depicted to her, in the most glowing colors 
and in the strongest and plainest language, the 
risks of the operation. When a surgeon, how- 
ever experienced or skilful, meets with a des- 
perate case, and finds that, after having in- 
formed his patient, that if an operation be 
performed, it will be likely to destroy him, he 
is willing and ready to incur the risk, his heart 
often fails him and he deeply regrets that the 
poor sufferer ever fell into his hands. So, no 
doubt, McDowell felt upon this occasion. 
" Having never," he said, "seen so large a sub- 



DEDICA TOR Y ADDRESS. 479 

stance extracted nor heard of an attempt or 
success attending any operation such as this 
required, I gave to the unhappy woman infor- 
mation of her dangerous situation. She seemed 
willing to undergo an experiment, which I 
promised to perform if she would come to Dan- 
ville, the town where I live, a distance of sixty 
miles." She did come, and the experiment, as 
McDowell very properly calls it, was, as already 
stated, performed. A rapid recovery ensued, 
and the patient, Mrs. Crawford, a Kentucky 
lady, survived the operation thirty-two years, 
enjoying for the most part excellent health, and 
dying at length in the seventy-ninth year of her 
age. Thus, it will be seen, this heroic and 
courageous woman owed nearly two-fifths of 
her life to the skill and care of her surgeon. 
Our admiration of this noble woman is greatly 
enhanced when we reflect that the operation 
was performed without the aid of anaesthetics, 
which were not introduced into practice until a 
third of a century afterward, as is our admira- 
tion of the surgeon when we recall the fact that 
he had no trained assistants to aid him in his 
work, executed despite the most strenuous and 
persistent efforts to dissuade him from under- 
taking it. 



4 8q MEMORIAL SERVICES. 

It is not a little remarkable that no account 
of this operation was published until eight years 
after it was performed. Whether this was due 
to inherent modesty on the part of McDowell, 
to indifference to fame, to sheer apathy, to an 
aversion to writing, or to fear of criticism, to 
which such an undertaking, without a precedent 
in the annals of surgery, would necessarily ex- 
pose him, it would be idle to conjecture. It is 
sufficient for my purpose to know that the first 
notice of it appeared, in 1817, in the Philadel- 
phia Eclectic Repertory and Analytical Review, 
The communication, which covered not quite 
three octavo pages of printed matter, was en- 
titled " Three Cases of Extirpation of Diseased 
Ovaria," and was drawn up so loosely and care- 
lessly as to be well calculated to elicit adverse 
criticism, as indeed it speedily did both at home 
and abroad in a way not at all calculated to re- 
flect credit upon the author as a literary and 
scientific man. The details of the cases were 
singularly meagre ; there was nothing said re- 
specting their origin, progress, or diagnosis, 
and even the operations themselves were very 
imperfectly described. If such operations had 
been performed in our day the most minute 
circumstances would have speedily found their 



DEDICA TOR Y ADDRESS. 4 g r 

way into print. The fact is, McDowell pos- 
sessed no facility as a writer, and he lacked that 
grace of diction and power of expression so 
well adapted to impart interest even to the 
driest details, and which can be acquired only 
by long practice. In a word, he was a stranger 
to the pen and had no fancy for its use. Writ- 
ing was a great bore to him ; a compulsory 
necessity. The report of his cases soon after 
its publication was severely criticised, and an 
attempt was to throw discredit upon his state- 
ments, or in other terms, to impugn his veracity. 
Had McDowell lived in our day, when intelli- 
gence flashes with lightning speed, not only 
from one section of the country to another but 
from continent to continent, such an occurrence 
would not have been possible. 

Dr. James Johnson, the very able and learned 
editor of the London Medico-Chirurgical Re- 
view, a journal widely circulated both in Great 
Britain and in the United States, was especially 
savage and satirical. He could not imagine it 
to be possible that an American surgeon, living 
in a small, obscure village in the wilds of Ken- 
tucky, or in the backwoods of America, as he 
expressed it, could perform such an operation, 

or become a pioneer in a new branch of sur- 
31 



482 MEMORIAL SERVICES. 

gery. In commenting upon McDowell's first 
case, especially upon the wonderfully rapid 
recovery of the patient, he exclaims apparently 
in holy horror and with uplifted hands, "Credat 
Judaus 11011 ego. 9 * In a subsequent article, 
published in 1827, Johnson again calls attention 
to McDowell's cases, adding that of five cases 
reported four had recovered and only one had 
died. "There were circumstances," remarks 
this Cerberus, " in the narratives of some of 
the first cases that raised misoqvino-s in our 
minds, for which uncharitableness we ask par- 
don of God, and of Dr. Ephraim McDowell, of 
Danville." It is presumable that this frank and 
manly recantation on the part of a man who 
occupied so elevated and influential a position 
as the editorship of the most widely read medi- 
cal journal in the world had some effect in 
controlling professional sentiment and inspiring 
confidence in the declarations of a surgeon 
whom he had only a few years before de- 
nounced as a backwoods operator unworthy of 
credence. Nevertheless Dr. McDowell had for 
a long time no imitators. Among those who, 
on this side of the Atlantic, had the courage to 
follow in his footsteps, were Nathan Smith, of 
New Haven, in 1821, Alban G. Smith, apart- 



DEDICA TOR Y ADDRESS. 483 

ner of McDowell, in 1823, and Dr. David L. 
Rogers, of New York, in 1829. All of the 
cases terminated favorably. McDowell him- 
self, as clearly as I could determine in prepar- 
ing my report on Kentucky Surgery, operated 
altogether thirteen times, with the result of 
eight cures, four deaths, and one failure, due to 
an inability to complete the operation on account 
of extensive adhesions of the tumor ; a degree 
of success which, considering the fact that he 
had no precepts except his own experience to 
guide him, was eminently creditable to his judg- 
ment, care, and skill, and which, although ex- 
ceeded in recent times, was for a third of a 
century pretty much the average in the hands 
of his followers, both in America and in Europe. 
If we go to the other side of the Atlantic we 
shall find that the first attempt at ovariotomy 
in Great Britain occurred in the practice of Mr. 
John Lizars, of Edinburgh. This gentleman, in 
1825, published a beautiful monograph upon 
the subject, in which he gave a detailed account 
of four cases, with two recoveries, one death, 
and one an utter and disgraceful failure, due to 
an erroneous diagnosis, both ovaries being per- 
fectly sound. Mr. Lizars, who was a surgeon 
of considerable note in his day, was led to turn 



484 MEMORIAL SERVICES. 

his attention to this subject from having read an 
account of McDowell's operations, which had 
accidentally fallen into his hands during the 
absence of Mr. John Bell, McDowell's old pre- 
ceptor, upon the continent, from which he never 
returned. The brochure here referred to was, 
there is reason to believe, of great service in 
calling to the subject the attention of European 
surgeons generally, the more especially as it 
embraced a full report of the Kentucky cases, 
which, up to that period, had lain, as it were, 
in a state of dormancy. Nothing, however, of 
any moment was done anywhere, either at 
home or abroad, until 1842, when ovariotomy 
received a new impulse at the hands of Dr. 
Charles Clay, of Manchester, England, followed 
shortly after by Dr. Frederick Bird, of London, 
and the two brothers Atlee, John and Washing- 
ton, of Pennsylvania, the first case of the for- 
mer having occurred in 1843 an d that of the 
latter in 1844. To these gentlemen is unques- 
tionably due the great merit of reviving the 
operation and of placing it upon a firm and 
immutable basis as one of the established pro- 
cedures in surgery. Their attempts to gene- 
ralize the operation met everywhere with great 
opposition and even obloquy. Dr. Clay, who 



DEDICA TOR Y ADDRESS. ^g 5 

introduced it into England, in referring to the 
subject, states that he had to wade through 
much vexatious opposition, great misapprehen- 
sions, and oross misunderstandings ■ and the 
experience of Dr. Washington L. Atlee was 
still more trying and annoying. In an address 
which he delivered in 1872 before the Philadel- 
phia County Medical Society, entitled " A 
Retrospect of the Struggles and Triumphs of 
Ovariotomy in Philadelphia," he depicts in 
glowing language the obstacles which this ope- 
ration had to encounter in this country and in 
his own city. "Ovariotomy," he exclaims, 
" was everywhere derided. It was denounced 
by the general profession, in the medical socie- 
ties, in all the medical colleges, and even by 
the majority of my own colleagues. I was 
misrepresented before the medical public, and 
was pointed at as a dangerous man, and even 
as a murderer. The opposition went so far 
that a celebrated professor, a popular teacher, 
and captivating writer, in his public lectures, 
invoked the law to arrest me in the perform- 
ance of this operation." This rancorous oppo- 
sition, however, founded as it was upon ignor- 
ance and prejudice, gradually wore away, and 
the men who were most clamorous in keeping 



^36 MEMORIAL SERVICES. 

it up either disappeared from the active scenes 
of life, or yielded gracefully to the light of 
reason and experience. Dr. Clay, writing in 
1874, states that he had operated upon two 
hundred and seventy-six cases, while those of 
Dr. Atlee, at the time of his death, less than a 
year ago, amounted to three hundred and 
eighty-seven. Mr. T. Spencer Wells, of Lon- 
don, whose brilliant career as an ovariotomist 
began in 1858, wrote to me on the 29th of 
April, 1879, that he had just had his nine hun- 
dred and thirty-eighth case. Mr. Thomas 
Keith, of Edinburgh, whose career in this field 
of surgery is also wonderfully brilliant, informs 
me, in a letter written a short time previously 
to that of his English confrere, that he had ope- 
rated up to that date two hundred and eighty- 
four times. Dr. John L. Atlee has operated 
fifty-seven times ; Dr. Alexander Dunlap, of 
Ohio, one hundred and forty-three times ; Dr. 
Edmund R. Peaslee, seventy-seven times ; 
Dr. T. Gaillard Thomas, one hundred and 
twenty-six times, and Dr. Gilman Kimball, the 
oldest and most-renowned American ovarioto- 
mist since the death of Dr. Washington L. 
Atlee, two hundred and forty times. Professor 
Briggs, of Nashville, who has operated upwards 



DEDICA TOR I " ADDRESS. 487 

of fifty times, recently had three cases of ovari- 
otomy on the same day, the patients living 
within a short distance of each other. 

It is an interesting fact with regard to the * 
history of ovariotomy in this country that Dr. 
John L. Atlee's first operation, performed in 
1843, was a ^ so tne fi rst operation in which both 
ovaries were removed. In the report of this 
remarkable case, an unusually elaborate one, 
in the American Journal of the Medical Sciences 
for January, 1844, after instituting a compari- 
son between this and other capital operations, 
Dr. Atlee makes a strong appeal in favor of 
ovariotomy. "Let this operation," he says, 
"but be placed upon its legitimate basis, and 
let it receive that attention from the profession 
which has been devoted to other departments 
of surgery, and we shall soon arrive at such a 
knowledge of the proper time and manner of 
operating, and before those complications exist 
which render it impracticable, as will be the 
means of saving many unfortunate and hope- 
less victims." When this operation was per- 
formed Dr. Atlee was not aware of the cases 
that had occurred in England in the practice of 
Dr. Clay and Mr. Walne, and he informs me 
that he would never have performed it if he 



4 gg MEMORIAL SERVICES. 

had not studied with great care the report of 
McDowell's cases. The success of his opera- 
tion, one of the most brilliant on record, in- 
duced him and his brother to repeat it on the 
first favorable opportunity, despite the opposi- 
tion and clamor of their professional brethren. 
Up to 1850 only eighteen American surgeons, 
including the originator, had performed this 
operation. In 1855 it received a new impulse 
from the publication of Dr. Washington L. 
Atlee's first thirty-five cases, and in the follow- 
ing year appeared the admirable prize-essay of 
Dr. George H. Lyman, of Boston, entitled 
"The History and Statistics of Ovariotomy," 
embracing a summary of three hundred cases, 
being all that were then known as having 
occurred in different parts of the world. On 
the continent of Europe ovariotomy made, 
until recently, very slow progress, although 
Chrysmar, of Germany, had performed it three 
times before the close of 1820, and conse- 
quently several years before it was attempted 
by Lizars, of Edinburgh. In France it was 
performed for the first time in 1847. ^ n these 
countries, as in the United States and Great 
Britain, it was long denounced as an unsafe 
and improper operation, and that this should 



DEDICA TOR Y ADDRESS. 



489 



have been the case is not surprising when we 
consider the enormous mortality which attended 
it, even in the hands of many of the most 
accomplished surgeons. The results of late 
years, however, have been more encouraging, 
and have been particularly flattering in the 
hands of Koeberle, of Strasbourg, Schroeder, 
of Berlin, and Skoeldberof, of Sweden, not to 
mention others. Ovariotomy is no longer on 
trial ; it has successfully passed that ordeal, 
and is now performed in every country of the 
earth where civilization has carried the bless- 
ings of scientific medicine. 

The frequency of ovarian diseases is appal- 
ling; far greater, indeed, than it is generally 
supposed to be. One surgeon alone, Dr. Clay, 
of England, declares that he had examined 
within a single decade eight hundred and fifty 
cases ! Who, in view of these occurrences, 
will deny the blessings of ovariotomy, espe- 
cially when we take into consideration the fact 
that few women laboring under maladies of this 
kind live longer than about four years, unless 
relieved by surgical interference ? 

The mortality of this operation is worthy of 
brief notice in connection with Dr. McDowell's 
name and fame. His own cases — thirteen in 



I - 



4q MEMORIAL SERVICES. 

number, with eight cures, four deaths, and one 
failure to complete the operation on account 
of extensive adhesions — show an astonishing 
degree of success when we recollect all the 
circumstances attending them, especially the 
operator's own inexperience, and the absence 
of any rules to guide him in his undertakings. 
For a number of years after McDowell's death 
the mortality in the hands of different surgeons 
exhibited but little improvement upon that in 
his own practice. Thus, of one thousand four 
hundred and eight cases collected by me in 
1872, from various sources, native and foreign, 
four hundred and fifteen died, affording a mor- 
tality of twenty-four per cent., or one death in 
every three and two-fifths cases. That the 
results of the operation are materially influ- 
enced by the manner in which it is performed, 
and by the previous and subsequent treatment, 
is a fact long since fully established. Thus, if 
we take the statistics of one hundred cases in 
the hands of so many different surgeons, men 
who have no experience in such cases and who 
follow the ordinary method of operating, the 
mortality will be found to be enormous, just as 
it would be likely to be under similar circum- 
stances in any other grave operation, as lith- 



DEDICA TOR Y ADDRESS. 



49I 



otomy the larger amputations, trephining of 
the skull, and the ligation of the larger arteries. 
No one will deny that experience is a most 
important factor in saving or destroying life in 
all the more serious, severe, or capital opera- 
tions. The results of ovariotomy in the hands 
of professed or skilled ovariotomists, men who 
make a specialty of abdominal surgery, are 
among the greatest triumphs of our art, en- 
titling them to be ranked among the noblest 
benefactors of the present day, or indeed of 
any day. The cases of Washington L. Atlee, 
Charles Clay, T. Spencer Wells, Thomas Keith, 
Gilman Kimball, Alexander Dunlap, T. Gaillard 
Thomas, and others, are counted, not by tens 
or twenties or thirties, but by hundreds. It is 
this enormous multiplication of cases that makes 
these men such experts and that gives them 
such a superiority over those whose practice is 
comparatively limited. One of the most grati- 
fying circumstances connected with this opera- 
tion is the gradually decreasing mortality even 
in the hands of the most successful surgeons. 
This is strikingly shown, to go no farther, by 
the statistics of Dr. Clay, of Manchester, who, 
as previously stated, introduced ovariotomy 
into England. Of the first twenty cases the 



492 MEMORIAL SERVICES. 

death-rate was one in two and one-half; of the 
second twenty, one in three and one-third ; and 
of the last thirty-one, one in four. In Mr. 
Wells's cases the same gratifying results are 
apparent, and so also in those of Mr. Keith, of 
Edinburgh. Who will dare to assert that these 
triumphs are not due to superior skill in operat- 
ing, and to increased care and experience, and 
not to the selection of the cases, although this 
will doubtless, now that the diagnosis between 
innocent and benign ovarian diseases is so well 
established, have its influence ? 

The attention bestowed upon the after-treat- 
ment must necessarily exert a powerful influ- 
ence upon the patient's fate. All the professed 
ovariotomists employ trained and experienced 
nurses and personally superintend their cases 
from first to last. Mr. Keith, in referring to 
this subject, says, " No one knows the anxiety 
that ovariotomy has given me, nor the time and 
thought and care I have bestowed on the pa- 
tients." There can be no doubt that the 
chances of recovery after the operation are 
greater when the patient is treated in a private 
hospital, situated upon airy ground, and pro- 
vided with all the means and appliances which 
such an institution ought to possess. This fact 



DEDICA TOR Y ADDRESS. 49 3 

has been strikingly exemplified in the practice 
of Mr. Keith, and also in that of Mr. Wells 
while he was in charge of the Samaritan Hos- 
pital, London. 

Leaving out of the question the results of 
less-experienced ovariotomists, what can be 
more wonderful than the results of Mr. Keith's 
cases — two hundred and eighty-four — with a 
mortality of only thirty-five, or one death in 
about eight operations ? Of the last one hun- 
dred and fifty-eight cases only twelve suc- 
cumbed ; of the last seventy-seven only thir- 
teen, and of the last forty-nine not one, thus 
verifying his assertion that "this long-despised 
operation is now the safest of all the great 
surgical operations, at least judging from these 
results." The statistics of the operations of 
Mr. Wells are equally astonishing. Both these 
surgeons are now making constant use of anti- 
septics, notwithstanding they obtained most 
brilliant results from the ordinary treatment, 
conducted with that care which their increasing 
experience had taught them to employ. Mr. 
Keith does not hesitate to ascribe much of his 
wonderful success in his late cases to the effi- 
cacy of antiseptics. Mr. Wells, in the letter 
previously referred to, says : "I began the year 



4Q 4 MEMORIAL SERVICES. 

1878 with the eight hundred and eighty-eighth 
case, by adopting the antiseptic system of Lis- 
ter, and have kept it up ever since, the result 
of forty-five cases being forty recoveries and 
five deaths. The recoveries have taken place, 
as a rule, without fever." " I believe," he adds, 
" that the antiseptic system will certainly reduce 
mortality and expedite convalescence." Of the 
thirty-eight cases of the ninth hundred, the 
number operated upon by Mr. Wells up to 
April 29, five, he informs me, have died, and 
thirty-three are well or convalescing. Of Mr. 
Clay's two hundred and seventy-six cases two 
hundred recovered and seventy-six died. 
Koeberle, during the last four years, operated 
one hundred times with eleven deaths. 

The mortality in Dr. Washington L. Atlee's 
three hundred and eighty-seven cases was, as I 
am informed by his son-in-law, Dr. Thomas M. 
Drysdale, about thirty per cent., which, consid- 
ering that he did not select his cases, and fre- 
quently had no opportunity of superintending 
the after-treatment, always a matter of such 
great moment in every severe operation, may 
be regarded as a fair average. Dr. John L. 
Atlee's fifty-seven cases show forty recoveries 
and twelve deaths, with five failures to complete 



DEDICA TOR Y ADDRESS. 49 5 

the operation on account of extensive adhesions. 
Of Dr. Dunlap's one hundred and forty-three 
patients one hundred and twelve recovered and 
thirty-one died. Of Dr. Peaslee's seventy- 
seven operations the results of twenty-eight 
only are positively known, and of these nine- 
teen recovered and nine perished. J. Taylor 
Bradford had thirty cases with three deaths. 
Professor T. Gaillard Thomas's one hundred 
and twenty-nine cases show ninety-six recov- 
eries and thirty-three deaths. The mortality 
of Dr. Kimball's cases is in the ratio of one to 
four ; of his last twenty-four cases twenty-one 
have recovered and three have died. 

It would be foreign to my purpose, in an 
address like this, and especially before such an 
audience, to speak of the causes which mainly 
influence the results of this operation ; but 
there is one circumstance to which I cannot 
forbear alluding. I refer to the importance of 
establishing in every case, before an operation 
is attempted, a correct diagnosis. Fortunately 
this can now be done, with proper care, almost 
in every instance, with the aid of the micro- 
scope. Dr. Thomas M. Drysdale, availing 
himself of the great opportunities afforded by 
Dr. Atlee's operations, has, after numerous 



496 MEMORIAL SERVICES. 

examinations, satisfied himself of the existence, 
in all innocent forms of ovarian cysts, of what 
he calls the "ovarian granule cells." These 
cells, which are very small and of a rounded or 
oval shape, are largely supplied with nuclei and 
nucleoli, and, as they are not present in any 
other affections or in dropsical fluids, they may 
be regarded as characteristic. More recently 
Dr. Foulis, of Edinburgh, and Dr. Knowsley 
Thornton, of London, have ascertained that 
malignant ovarian tumors can be distinguished 
from benign ovarian growths by the presence 
of groups of large, pear-shaped, round, or oval 
cells, occupied by granular material with nuclei, 
nucleoli, vacuoles, or transparent globules. 
The value of these researches, in which Dr. 
Drysdale has taken the lead, cannot, in a 
diagnostic point of view, be overestimated, for 
they clearly indicate the necessity, in every 
case of doubt, of making a thorough examina- 
tion of the contents of these classes of tumors 
before finally deciding upon the propriety of 
using the knife. 

The brilliant success which has attended 
ovariotomy both in America and in Europe has 
led to an extension of the whole domain of 
abdominal surgery, and has emboldened ope- 



DEDICA TOR Y ADDRESS. 



497 



rators to invade other regions of the body 
until recently regarded as too sacred to be 
meddled with. Indeed, there would seem to 
be hardly any longer any forbidden territory. 
The uterus, the spleen, and the kidneys have 
of late years been the coveted objects of the 
surgeon's cupidity. Very lately the gall-bladder 
has not only been aspirated for the purpose of 
relieving it of distending fluids, but actually, in 
several instances, extirpated. Many years ago, 
during my residence in Kentucky, I received a 
telegram from a distinguished surgeon of Co- 
lumbus, Ohio, saying he had just excised the 
liver, and that as his patient was progressing 
favorably he indulged great hope of her re- 
covery. The woman, however, died the next 
morning, when it was discovered that, instead 
of the liver, only an ovary had been removed, 
thus depriving my friend of the glory of being 
a pioneer in hepatic surgery! Within the last 
ten years a number of cases of excision of the 
larynx have been reported, including, in some 
instances, portions of the tongue and of the 
oesophagus, and yet despite the mutilation some 
of the survivors, with the aid of an artificial 
substitute, articulated nearly as well, it would 

seem, as before the operation. The entire 

32 



4g8 memorial services. 

tongue, too, has on a number of occasions — 
perhaps in not less than forty or fifty cases — 
been extirpated with, as is alleged, very little 
impairment of the patient's voice or power of 
speech. With such inroads, such innovations, 
on the part of surgery, we need not be sur- 
prised if, on waking some morning, we should 
find the papers filled with accounts of the suc- 
cessful amputation of the head without any 
serious detriment to the patient's mental 
faculties, despite the assertion of Mons. Blan- 
din, a French surgeon, that this portion of the 
body, which he invariably designates as the 
encephalic extremity, cannot be removed dur- 
ing life without stopping respiration and caus- 
ing other inconveniences which, unhappily, 
render the operation inadmissible ! This lan- 
guage, however, it must not be forgotten, was 
uttered fifty years ago, when surgery was in a 
comparatively crude condition, and is therefore 
hardly applicable at the present day. But, 
pleasantry aside, as perhaps unbecoming the 
occasion, while I have always been a friend to 
progress, it is evident that there must be limits 
to the use of the knife. What the fate of some 
of these operations may be, whether any or all 
of them will be ultimately admitted into the 



DEDICA TOR Y A DDR ESS. 499 

domain of legitimate surgery, must for the 
present remain an open question. We are no 
more justified now in condemning what may 
seem to us to be an improper operation than 
physicians were in the days of McDowell in 
condemning ovariotomy. Experience alone 
can determine how far the knife shall go or 
shall not go. 

What has been called, perhaps oddly enough, 
normal ovariotomy, an operation first performed 
by Dr. Robert Battey, of Georgia, may be 
regarded as a natural outgrowth of McDowell's 
operation, or ordinary ovariotomy, rendered 
necessary, as is alleged, on account of organic 
or functional disorder of the ovaries, incurable 
by ordinary treatment. The results obtained 
thus far are not very satisfactory, and it is evi- 
dent that further light is required before we 
can determine its real merits. Different me- 
thods of reaching the faulty structures have 
been suggested, but there is not one that is 
wholly free from danger, while that originally 
practised by the courageous and ingenious in- 
ventor does not always afford sufficient space 
for the purpose. 

The statistics of this operation published in 
1878 by Dr. George J. Engelmann, of St. 



T^ 



^00 MEMORIAL SERVICES. 

Louis, embracing forty-three cases, show that 
the risk is very considerably greater than in 
ordinary ovariotomy, fourteen of the cases ter- 
minating fatally, while of the twenty-nine sur- 
viving patients nine only, or thirty-one per 
cent., were cured, and eleven were more or 
less improved. Many of the operations were 
not completed on account of the impossibility of 
extracting the entire ovary. 

Dr. Battey, as he informed me only a few 
days ago, has performed this operation fifteen 
times with two deaths and thirteen recoveries. 
Of these thirteen cases four were promptly 
and entirely cured, nine were benefited, and of 
those not completely relieved every one had 
made notable progress during the last twelve 
months. 

In delineating the character of McDowell 
the question naturally arises, how was he led to 
perform for the first time in the history of sur- 
gery so dangerous an operation ? Was it his 
superior knowledge of abdominal and pelvic 
diseases, or had he made a special study of 
them, and thus qualified himself above all other 
men to become a pioneer in a branch of sur- 
gery whose territory had never before been 
invaded by the knife? Or was it his superior 



DEDICA TOR Y ADDRESS. 



501 



sagacity or his more profound penetration 
which led him to undertake it? Finally, had 
the lessons which as a student he imbibed in 
the lecture-room during his sojourn at Edin- 
burgh any agency in the matter ? It must not 
be forgotten, in discussing this subject, that long 
before McDowell launched into this then unex- 
plored field of surgery a number of distin- 
guished physicians, in view of the hopeless 
character of ovarian diseases, suggested their 
removal through an opening in the wall of the 
abdomen. Among others who seriously thought 
of the matter may be mentioned more especially 
the names of Schlenker, Willius, Preger, Cham- 
bon, and the celebrated William Hunter, the 
foremost obstetrician of his day in Great 
Britain. None of these men, however, had the 
courage to undertake such an operation. Prior 
to McDowell no surgeon had been so bold as 
to do more than to open occasionally an ova- 
rian cyst and to let out its contents. No one 
had dared to remove an ovarian tumor of any 
kind bodily. 

In reflecting upon this subject I have always 
thought that the instruction which McDowell 
had received while attending the lectures of the 
celebrated Mr. John Bell, of Edinburgh, had 



Ej02 MEMORIAL SERVICES. 

mainly paved the way to this undertaking. It 
is a well-known fact that the young Kentuckian 
was greatly impressed by the lectures of this 
great surgeon, who was a man of splendid 
genius, of high intellectual endowments, an 
eloquent teacher, and a bold, dashing operator, 
then in the zenith of his renown. We may 
well imagine with what pathos such a man, a 
man of the most ardent temperament and a 
most accomplished scholar, would describe 
abdominal surgery, and with what force and 
emphasis he would dwell upon the hopeless 
character of ovarian tumors. No man, perhaps, 
ever taught surgery to more admiring pupils, 
or more completely fascinated them by the 
power of his eloquence. There was, moreover, 
from all accounts, a wonderful magnetism about 
John Bell, which drew to him, as with an irre- 
sistible charm, every one who came within his 
presence. Listening to the lectures of such an 
enthusiast, a kind of Tom Marshall in his way, 
it is not probable that the young American sat 
listlessly with closed eyes and ears upon the 
hard bench of the amphitheatre. On the con- 
trary, his attention was all agog. We can see 
him even now, as it were, with open mouth and 
protruding head, with his chin resting upon his 



DEDICA TOR Y ADDRESS. * Q ■, 

hands, eagerly drinking in every word as it fell 
from the lips of this divine son of yEsculapius. 
The sparks of genius which such a teacher 
emits kindle a flame in the minds of his pupils 
which the waters of all the rivers and seas of 
the earth cannot extinguish. That the pre- 
lections of this wonderful man exerted a 
powerful influence in moulding the character of 
McDowell and in inspiring him with boldness 
and confidence as an operator is unquestionable. 
How far they affected his career as an ovari- 
otomist is of course a mere matter of conjec- 
ture. The knowledge which he brought home 
with him, and his warm sympathy for suffering 
woman, no doubt exercised a powerful effect 
upon his future life. Besides, he was not un- 
aware of the fact that success had often 
attended the Caesarean section, and that persons 
not unfrequently recovered after severe wounds 
and other injuries of the abdominal and pelvic 
viscera. Moreover, it is not improbable that, 
in reflecting upon the subject, he came to the 
conclusion, long since universally recognized, 
that the peritoneum, when chronically diseased, 
is generally comparatively tolerant of the 
rudest manipulation, whereas the slightest ex- 
posure of, or interference with, the healthy 



t<04 MEMORIAL SERVICES. 

membrane is sure to be promptly resented, 
almost invariably, indeed, at the expense of the 
patient's life. Finally, it must not be forgotten 
that McDowell was a bold surgeon, and a man 
of a broad, elevated mind, capable of taking a 
comprehensive view of anything that was pre- 
sented to him. With a heart as tender and 
gentle as that of a woman, he was not afraid of 
the sight of blood. For many years he had 
the field of surgery in Kentucky almost wholly 
in his own hands. He had not been home long- 
from his foreign residence before patients began 
to flock to him from all parts of the southwest, 
and he found himself immersed in a large sur- 
gical practice, demanding the performance not 
only of the more common but also of many of 
the more difficult and severe operations. His 
first case of ovariotomy occurred when he had 
hardly been twelve years engaged in the prac- 
tice of his profession. He was about the same 
age as Valentine Mott when he performed his 
great feat of tying for the first time the innomi- 
nate artery ; an operation in comparison with 
that of McDowell of utter insignificance, for of 
the nineteen or twenty cases in which it has 
been done only one life has been saved, whereas 
the other has already restored to health and 
comfort upwards of two thousand women. 



DEDICA TORY ADDRESS. 



505 



The career of McDowell is so intimately 
bound up in the great operation already so fre- 
quently mentioned that one might suppose 
nothing of interest remained to be considered. 
This, however, is far from being the case. In 
many respects, indeed, it is replete with inci- 
dents. Born in Rockbridge County, Virginia, 
in 1 771, he was brought, when hardly two 
years old, by his parents to Danville, at a time 
when Kentucky was literally a wilderness, re- 
sounding with the howl of the panther and of 
the savage and reeking with the blood of its 
early settlers. The terrible battle fought near 
Blue Lick Springs, in which Daniel Boone 
played so conspicuous a part and lost a son, 
and which proved to be so disastrous to his 
followers and companions in arms, took place 
only a short time after this event, and filled the 
country with pain and sorrow. The frequent 
wars of which it was the theater gave it a pecu- 
liar claim to the title of the " Dark and Bloody 
Ground," from which it derived its name. At 
the period in question Kentucky was still a ter- 
ritory, and it was not until after repeated con- 
ventions, the last of which was held in this city, 
that it was finally, in June, 1792, admitted as a 
State into the Union. 



r Q 6 MEMORIAL SERVICES. 

McDowell was of Scotch-Irish parentage, and 
the ninth of twelve children. His great-grand- 
father, after whom he was named, was Ephraim 
McDowell, a brave and courageous man, who, 
after having done some fighting in the civil wars 
of Ireland, in the cause of the Covenanters, 
emigrated, after he was past middle life, to 
Pennsylvania, which he left in 1737 for Augusta 
County, Virginia, where he died at a very ad- 
vanced age shortly before the revolutionary 
war. From an elaborate genealogical article 
in the Cincinnati Commercial, January 14, 1879, 
under the nom de plume of Keith, it appears 
that the descendants of the Scotch-Irish emi- 
grant have become almost as numerous as the 
sands upon the sea-shore, and that they repre- 
sent by their intermarriages many of the most 
respectable and influential families in Maryland, 
Virginia, Kentucky, Ohio, Illinois, Indiana, Mis- 
souri, and indeed almost In the entire south- 
west. If called together they would form, at 
least numerically, a powerful clan. Besides the 
great surgeon, who has immortalized the family, 
many of these people have held important 
positions, as governors of different States, con- 
gressmen, lawyers, judges, divines, physicians, 
politicians, and army officers. Joseph Nashe 



DEDICA TOR Y ADDRESS. 



507 



McDowell, who died only a few years ago, was 
a nephew of Ephraim, a great teacher of 
anatomy and surgery, and the founder of a 
medical school at St. Louis. Another nephew, 
the late Dr. William A. McDowell, of Louis- 
ville, occupied a high position as a sagacious 
and successful physician. The name of Gen. 
Irvine McDowell, United States Army, is 
familiar to every American citizen. The father 
of Ephraim was Samuel McDowell, an accom- 
plished gentleman, a member of the Legisla- 
ture of Virginia, and, after his removal to 
Danville, a judge of the district court, a posi- 
tion which he held until within a short time of 
his death. On his mother's side he was de- 
scended from the McClungs, a distinguished 
family of Virginia. The son's early education 
was obtained at a classical seminary at George- 
town, in his adopted State, under the super- 
vision of Messrs. Worley and James, two 
accomplished teachers. How long he remained 
here, or what progress he made in his studies, 
I am unable to say, but it is safe to affirm that, 
although he was fond in after life of literary 
reading, his primary education was sadly neg- 
lected, and that he never surmounted his early 
deficiencies. He wrote, as has already been 



c 8 MEMORIAL SERVICES. 

stated, with great difficulty, and his only literary 
contributions are two short articles contained 
in the Philadelphia Medical Repertory and 
Analytical Review for 1817 and 18 19. His 
medical education was commenced in the office 
of an eminent physician, Dr. Humphreys, of 
Staunton, Virginia, a graduate of the Univer- 
sity of Edinburgh. It was doubtless through 
the influence of his preceptor that the youth 
determined to go at once to the fountain-head 
of medical education and learning, as the Scotch 
metropolis was then very justly regarded. At 
all events there is no proof to show that he 
ever attended any lectures in Philadelphia, at 
that time the only place of resort for the medi- 
cal student in this country. The University of 
Edinburgh, of which he was a member in 1793- 
4, enjoyed a world-wide reputation at this period 
on account of the learning and ability of its 
professors, among whom may be mentioned as 
especially worthy of notice the names of Cullen 
and Black, two great luminaries, whose fame 
added lustre to the school and attracted pupils 
from all parts of the civilized world. Not 
waiting to take a degree, he immediately, upon 
his return to America, settled at Danville, 
where, having brought with him the prestige of 



DEDICA TOR Y ADDRESS. 



509 



foreign study, he soon acquired the confidence 
of the public and rapidly rose to distinction as a 
successful practitioner. He particularly distin- 
guished himself as a surgeon and as an expert 
operator, a position of which he retained undis- 
puted possession until the organization, in 18 19, 
of the medical school at Lexington, when he 
was gradually eclipsed by his young rival, Dr. 
Benjamin Winslow Dudley, a gentleman of 
highly fascinating manners, a popular teacher, 
and, as all the world knows, a great surgeon. 

It is not the design of this address to enter 
into minute details respecting Dr. McDowell's 
more ordinary surgical achievements. It will 
subserve my purpose to state that he was an 
excellent lithotomist, and that he repeatedly 
performed many of the great operations of 
surgery. The subject of one of these opera- 
tions was James K. Polk, afterward President 
of the United States, at the time a thin, ema- 
ciated stripling, fourteen years of age, worn 
out by disease, uneducated, and without appa- 
rent promise of future usefulness or distinction. 
"As an operator," as Dr. Alban G. Smith, who 
late in life changed his name to Dr. Goldsmith, 
and who knew him well, having at one time 
been his partner, told me, "as an operator he 



5io MEMORIAL SERVICES. 

was the best I ever saw in all cases in which he 
had a rule to guide him ;" no slight praise from 
a man who was himself an expert operator ; 
and yet Dr. Goldsmith seemed to forget that 
this man did certainly once operate in a case 
in which he had no rule to guide him, a case 
which was destined to confer immortality upon 
his name. 

McDowell was not only a good operator, but 
he possessed all the higher attributes which 
make up the character of a great surgeon, 
intense conscientiousness and a scrupulous 
regard for the welfare of his patients. He 
never operated merely for the sake of operat- 
ing. He had always an eye to consequences. 
For the mere mechanical surgeon he had an 
immitigable contempt. In speaking of ovari- 
otomy, in answer to some strictures pronounced 
upon his first three cases, he expresses the 
hope that no such surgeon will ever attempt it. 
"It is," he adds, "my most ardent wish that 
this operation may remain to the mechanical 
surgeon for ever incomprehensible." He con- 
sidered the profession of medicine as a high 
and holy office, and physicians as ministering 
angels, whose duty it is to relieve human suffer- 
ing and to glorify God. He had a warm and 



DEDICA TOR Y ADDRESS. 



511 



loving heart, in full sympathy with the world 
around him. To the sick poor he was particu- 
larly kind. He was a loyal and devoted hus- 
band, a tender and loving father, an honest, 
hiorh-toned citizen. In all the relations of life 
he was a model. Naturally of a lively, social 
disposition, he enjoyed a good joke or a spicy 
anecdote, and was the delight of every social 
entertainment which he honored with his pres- 
ence. Late in life he devoted much of his 
leisure to reading and meditation. His favorite 
medical authors were Sydenham and Cullen ; 
his favorite literary authors, Burns and Scott. 
During his sojourn in Scotland he passed seve- 
ral months of his vacation in rambling over the 
country trying to make himself familiar with 
the nature and habits of the peasantry. In 
these perambulations he had the society of two 
of his Kentucky friends, Drs. Brown and Speed, 
the former of whom became afterward Pro- 
fessor of Medicine in Transylvania University. 
When the trio reached home some one asked 
Brown, "What do you think of McDowell?" 
" Think of him ? . Why, he went abroad as a 
gosling and has come back as a goose." It 
would be well if our country had more of such 
birds ! He had little confidence in the efficacy 



512 



MEMORIAL SER VICES. 



of medicine, and constantly cautioned his stu- 
dents against the too free use of drugs, saying 
that they were more of a curse than a blessing. 
He considered surgery as the most certain 
branch of the healing art, and spared no means 
to extend his knowledge of it. He was an 
excellent anatomist, and it is said that he never 
performed any serious operation without pre- 
viously recalling to his mind the structures 
involved in it. In 1817 the Medical Society of 
Philadelphia sent him its diploma of member- 
ship, and in 1825 the University of Maryland 
conferred on him the degree of Doctor of 
Medicine. At the age of thirty-one he married 
Sallie, daughter of Gov. Isaac Shelby, of Ken- 
tucky, by whom he had six children, two sons 
and four daughters, two of the latter of whom, 
Mrs. Deadrick, of Tennessee, and Mrs. Ander- 
son, of Paris, Missouri, are still living at an 
advanced age, the parents of large and highly 
respectable families. He was nearly six feet 
in height, with a florid complexion, black eyes, 
a commanding presence and remarkable mus- 
cular powers. As an illustration of his great 
physical strength, he used to tell with peculiar 
glee an anecdote of a circumstance which 
occurred while he attended medical lectures at 



DEDICA TOR Y ADDRESS. 



513 



Edinburgh. One day, as the story goes, a 
celebrated Irish foot-racer, a kind of Mike 
Fink, arrived, boasting that he could out-run, 
out-hop, and out-jump any man in the city, and 
bantered the whole medical class. McDowell 
was selected as their champion, the distance 
being sixty feet, the stake ten guineas. The 
backwoodsman purposely allowed himself to be 
beaten. A second race for one hundred 
guineas, at an increased distance, came off soon 
afterward, and this time the Irishman, after 
much bullying, was badly worsted, much to his 
own chagrin and the delight of the students. 

Although McDowell's means were not large 
he was liberal in the bestowal of his charities, 
and generous to a fault in his dealings with his 
patients. In 1828, only two years before his 
death, he united himself with the Episcopal 
Church, of which he remained a zealous and 
consistent member. A vein of piety ran 
through his whole life. As a proof of this 
fact it may be stated that he always preferred 
to perform any great operation that he might - 
have on hand on the Sabbath, knowing, as he / 
affirmed, that he would then have the prayers 
of the church with him. Trinity Church of 
Danville was the special object of his care ; 

33 



c I4 MEMORIAL SERVICES. 

and as an evidence of the interest he felt in it 
I may mention, what does not seem to be gen- 
erally known even among your own citizens, 
that he gave it the lot upon which the present 
building is situated. Indeed McDowell, to use 
the language of one of your most noble and 
accomplished women, was the head and front 
of its van-guard, which embraced many dis- 
tinguished names in ' the past history of this 
portion of Kentucky. Of Center College he 
was one of the founders and orio-inal trustees. 

o 

Such, fellow-citizens of Kentucky, was the 
character of Ephraim McDowell ; kind-hearted, 
benevolent, and just in all his dealings, an ex- 
cellent citizen, an original thinker, a bold, fear- 
less, but most judicious surgeon, and, above all, 
a Christian gentleman. Such, citizens of Dan- 
ville, was your former townsman, whose career 
has shed so much lustre upon his age and 
country, and who, if he could be in our midst 
this day, might justly echo the words of the 
Roman poet, " Exegi monumentum cere per en- 
nius." 

The latter years of this good man's life were 
clouded by an attempt made, strange as it may 
appear, by one of his own nephews and private 
pupils, to deprive him of his claims as the origi- 



DEDICA TOR Y ADDRESS. 



515 



nator of the operation so frequently mentioned. 
This circumstance induced him, in 1826, only a 
few years before his death, to address a printed 
circular to the physicians and surgeons of the 
West in vindication of his rights. Without 
entering into any particulars respecting this 
matter, I am satisfied, from a careful examina- 
tion of all the facts connected with it, that the 
pretensions set up by this gentleman, were, like 
the ''baseless fabric of a vision," without the 
slightest foundation in truth. 

It was not given to McDowell to see the fruit 
of his labors beyond the limits of his own coun- 
try ; the seed which he sowed fell upon meagre 
soil, and was slow in germinating. Now and 
then, it is true, a blossom shot forth and shed 
its fragrance upon the air, but fully a quarter 
of a century elapsed before it ripened into 
vigorous fruit. No single age has ever wit- 
nessed the birth and the maturity of any branch 
of human knowledge. McDowell lived in 
vance of his time and of his profession 
boldness, as his contemporaries were inclined 
to view his conduct, took them by surprise, and 
shocked their sensibilities ; hence, instead of 
investigating the merits of his operation, as 
reasonable men should and would have done, 



1 ad- ^y 

; his / 



cj6 memorial services. 

they rejected it as the device of a crack-brained 
man, who deserved to be prosecuted for a vio- 
lation of the sixth commandment. It was un- 
fortunate for McDowell that he lived at a time 
when there were no societies for the diffusion 
of knowledge, and when the means of com- 
municating intelligence were so scanty as they 
were in the early part of the present century. 
Xews at that period of our history, locked up 
as it always was in the mail-bags of the cumber- 
some four-wheeled stage-coach, was often stale 
before it reached its destination. In those days, 
as well as for a lonof time afterward, there were 
no railroads, no steamships, no telegraphs. The 
world moved at a snail-like pace, or, as it were, 
upon the back of a tortoise, at the rate of six 
or eight miles an hour. To publish reports of 
medical cases or of surgical operations was 
then, as it is now, unprofessional. Besides, 
even if such a course had been permissible they 
would have found their way very tardily to the 
public. Journalism was at a low ebb; there 
were comparatively few newspapers, and news- 
paper reporters had no existence. Medical 
news travelled still more slowly than miscellan- 
eous. In 1S17, when McDowell's first three 
cases were reported in the Philadelphia Medical 



DEDICA TOR V ADDRESS. 



517 



Repertory and Analytical Review, there was, if 
I mistake not, only one other medical periodi- 
cal in the United States. Had McDowell's 
operation been performed in our day the news 
would have spread far and wide within the first 
twenty-four hours, and in an almost incredibly 
short time would have been carried to the ut- 
most limits of civilization. As it was, it was 
locked up first for eight years in the brain of its 
originator, and then in an obscure medical jour- 
nal, and when at length it reached the other 
side of the Atlantic it met only with ridicule and 
incredulity. 

An account of McDowell's first three cases 
was, it seems, sent to Dr. Physick, of Philadel- 
phia, but from some cause or other it failed to 
interest him or to attract his attention. He 
probably knew little or nothing of the back- 
woods surgeon, and therefore, it may be, looked 
upon him as an adventurer unworthy of notice. 
However this may be, it fared much better in 
the hands of Dr. James, the amiable Professor 
of Midwifery in the University of Pennsylvania. 
This gentleman, deeply impressed with the 
novelty and importance of the subject, and 
thoroughly acquainted with the hopeless char- 
acter of the ordinary treatment of ovarian dis- 



C!8 MEMORIAL SERVICES. 

eases, read an account of the cases before his 
class, and caused it shortly after to be published 
in the journal already several times referred to, 
and of which, in fact, he was one of the editors. 
He, however, failed to make any editorial com- 
ments upon the subject, or to defend the opera- 
tion when assailed by ignorant critics. Mc- 
Dowell also sent an abstract of his cases to 
his old master, Mr. John Bell, but as this 
gentleman had been for some time absent on 
the Continent, and not long afterward died 
at Rome, it never reached him. The paper, 
however, fell into the hands of one of his pupils, 
Mr. John Lizars, of Edinburgh, by whom it was 
published in the Edinburgh Medical a?id Sur- 
gical Journal for 1824. Mr. Lizars, as before 
stated, was the first to perform McDowell's 
operation in Great Britain. 

In no pursuit of life does history repeat itself 
more frequently than in affairs relating to human 
progress, innovation, and discovery. From this 
occurrence our profession is not exempt. The 
history of the discovery of the circulation of the 
blood, one of the most brilliant achievements of 
the human intellect in the seventeenth century, 
is a striking instance in point. Of Harvey's 
contemporaries not one, it is said, over forty 



DEDICA TOR Y ADDRESS. 



519 



years of age accepted his teachings. Many 
years elapsed before the value of vaccination 
was fully recognized, and even now an opera- 
tion which has saved millions of lives has its 
opponents not alone among the vulgar, but 
among otherwise highly enlightened people. 
The use of the stethoscope as a means of diag- 
nosis was long rejected by medical men, and 
the speculum, an instrument as old as Hercula- 
neum, reintroduced to the notice of the profes- 
sion less than fifty years ago by Recamier, of 
Paris, met with no better fate. Everybody 
knows with what suspicion many physicians 
regarded the employment of anaesthetics, and 
it is fair to say that much prejudice in regard 
to the use of this class of remedies still lingers 
in the public mind. Ignorance, superstition, 
and prejudice have ever been giants in the path 
of progress. 

The idea of erecting a monument to the 
memory of Dr. McDowell originated with one 
of the citizens of Danville, the late lamented 
Dr. John D. Jackson, a gentleman whose death, 
a few years ago, in the prime of life, threw a 
whole community into mourning, and whose 
memory will long be cherished on account of 
his varied accomplishments as a physician, his 



c 2 o MEMORIAL SERVICES. 

lovable character as a man, and the many 
amiable impulses of his great heart. This idea 
was in due time communicated to the Kentucky 
State Medical Society, of which Dr. Jackson 
was a prominent member, and acted upon 
through a committee whose duty it became to 
collect the necessary funds for carrying out the 
noble design. This committee made known 
its wishes not only to the profession of this 
country, but to our brethren in Europe, and 
also, if I mistake not, to the women who had 
been the fortunate recipients of the fruits of 
Dr. McDowell's operation: Finally, in 1875, a 
stirring appeal was made to the American 
Medical Association at its annual meeting at 
Louisville in May of that year. From none of 
these sources, however, was any substantial aid 
derived, and it devolved at last upon the society 
in which the design originated to furnish nearly 
the entire sum necessary to carry it into execu- 
tion. 1 

1 All, in fact, that the American Medical Association did was 
to pass an empty resolution, leaving, as the illustrious chairman, 
Dr. J. Marion Sims, expressed it, " to Kentucky the grateful 
privilege of providing a local monument to the memory of Dr. 
McDowell," and requesting the Association to contribute 
through its individual members the sum of ten thousand 
dollars as a fund, to be called the " McDowell Memorial 



DEDICA TOR Y ADDRESS. 



521 



While, therefore, the granite shaft which 
graces yonder cemetery is a just tribute to the 
memory of a great and good man, whose title 
to immortality is well founded, let us not forget 
the part borne in its erection by the Kentucky 
Medical Society, which had the sagacity to per- 
ceive, and the liberality to execute, a design 
which reflects so much credit upon the medical 
profession and the State of Kentucky. I feel 
a just pride when I recall the fact that I was 
one of the founders of a society which now 
includes among its members nearly all the 
medical talent, culture, and refinement of the 
State, and which has established a reputation 
for ability, learning, and enterprise not ex- 
ceeded by any similar association in the United 
States. Dr. McDowell is not the only physi- 
cian of whom Kentucky has reason to be 
proud. She furnished the first case of hip-joint 
amputation on this continent in the hands of 
Dr. Walter Brashear, of Bardstown, of lithot- 
rity in the practice of Dr. Alban G. Smith, of 
Danville, and the most flattering results in 



Fund," to be devoted to the payment of prizes for the best 
essays relating to the diseases and surgery of the ovaries. This 
fund is still unborn, and it is not probable that it will receive 
any further attention from the Association. 



-22 MEMORIAL SERVICES. 

ovariotomy in the hands of Dr. J. Taylor Brad- 
ford, of Augusta. The triumphs of Dr. Benja- 
min W. Dudley in lithotomy established for 
him an unrivalled reputation in his day as a 
great operator in calculous affections. Her 
medical teachers were for a long time, as they 
still are, amone the foremost in the land, and 
it is but just to say that her practitioners have 
nowhere any superiors. Kentucky was the 
first State west of the Allegheny Mountains to 
establish a medical school and to send forth its 
first medical graduate in the West. If in state- 
manship she may boast of a Clay and of a " sil- 
ver-tongued" Crittenden, whose eloquence en- 
chained admiring" audiences, and elicited the 
applause of the senate chamber ; if her bar was 
long known as one of the most elegant, astute, 
and learned in the land ; if her pulpit was 
dignified by the piety, erudition, and oratory of 
her Campbells and her Breckinridges, and is 
still adorned by her Humphreys, her Robin- 
sons, and other great divines, she has their 
counterparts in her Caldwell, her Drake, her 
Dudley, her Miller, her Rogers, her Yandell, 
her Bush, and other great physicians whose 
names stand high upon the roll of fame, and 
who, if they had directed their attention to 



DEDICA TOR Y ADDRESS. 



523 



other pursuits, would have been equally dis- 
tinguished. These men need no monuments 
to perpetuate their virtues or. their services ; 
their names live in the esteem and affection of 
their fellow-citizens, engraved in good acts, de- 
siened to relieve human suffering 1 and to exalt 
the dignity of human nature. 

I stop here for a moment to ask, What is the 
object of a monument? Is it to glorify the 
dead or to encourage the living ? The boy, as 
he passes along Charles Street, Baltimore, 
under the shadow of the Washington monu- 
ment, pauses to read the inscription upon its 
entablature : " Erected by the State of Mary- 
land in grateful recognition of the virtues and 
services of the ' Father of his Country.' " He 
gazes at the august figure at the top, and dis- 
covers in it all the attributes of a great man ; he 
goes home and curiosity impels him to inquire 
into his character ; perhaps he consults his 
childish history, and there finds that Washing- 
ton, the grandest subject of all history, was the 
saviour of his country ; like himself, at one 
time, an obscure youth, but now, long after his 
death, the idol of the American people. He 
has learned an important lesson ; his ambition 
is roused ; his energies have received a new 



___„ 



5 24 MEMORIAL SERVICES. 

impulse; in a word, new life has been infused 
into his soul, and that boy is already the com- 
ing man. The granite shaft which we have this 
day dedicated to the memory of McDowell is a 
living biography, designed not merely to com- 
memorate the virtues and services of a great 
and good man, but to excite the emulation of 
Kentucky's youths and to urge them on to 
deeds of valor and of humanity. A country 
without monuments is a country without civili- 
zation. 

I cannot forbear introducing here the appro- 
priate and beautiful remarks of an old and dis- 
tinguished pupil, Dr. David W. Yandell, made 
upon a recent festive occasion, when contrast- 
ing the fame of the statesmen, the orators, and 
the military men of Kentucky with that of 
McDowell. " Chief among all these,'' says my 
eloquent friend, "is he who bears the mark of 
our guild, Ephraim McDowell ; for the labors 
of the statesman will give way to the pitiless 
logic of events, the voice of the orator grow 
fainter in the coming ages, and the deeds of 
the soldier eventually find place only in the 
library of the student of military compaigns ; 
while the achievements of the village surgeon, 
like the widening waves of the inviolate sea, 



DEDICA TOR Y ADDRESS. 



525 



shall reach the uttermost shores of time, hailed 
by all civilizations as having lessened the suffer- 
ing and lengthened the span of human life." 

In selecting Danville for the site of the 
" McDowell Monument" the Kentucky State 
Medical Society made a happy choice, for it 
was here that the Father of Ovariotomy encoun- 
tered and vanquished his early professional 
struggles ; here that he performed his great 
achievements ; here that at the close of a well- 
spent life he was laid quietly in the grave. 
When McDowell, after his return from Europe, 
began the practice of medicine here, Danville 
contained a mere handful of inhabitants ; but 
he soon identified himself with its prosperity, 
watching its progress with a jealous eye, and 
contributing largely by his means and his good 
sense to make it what it now emphatically is, the 
Athens of the West, a distinction at one time 
so justly conceded to her near neighbor Lex- 
ington. Its institutions of learning have be- 
come the foremost in the State. Center Col- 
lege has educated many of Kentucky's greatest 
citizens. Its theological school has widely dis- 
seminated the lessons of Christianity. Its 
female seminaries have planted the seeds of 
virtue, piety, and learning in the hearts and 



c 2 6 MEMORIAL SERVICES. 

minds of her young women. The institution 
for the education of deaf-mutes was the first of 
the kind established in the West. Founded in 
1823, shortly after those at Hartford, Philadel- 
phia, and New York, it gradually, despite 
great obstacles, attained, under the wise man- 
agement and fostering care of the late Mr. 
John A. Jacobs, extending over a period of 
forty-four years, a degree of reputation not less 
creditable to the country at large than to his 
adopted State. His death in 1869 was a public 
loss, widely deplored. 

Nearly forty years have elapsed since I was 
called to the chair of surgery in the University 
of Louisville, and responded, along with Pro- 
fessor Drake, at the request of my colleagues, 
to an invitation issued by the late Dr. William 
L. Sutton, of Georgetown, to assist in forming 
a State medical society. The first attempt 
proved abortive, but another, made under more 
favorable auspices several years later, was suc- 
cessful, and the society soon assumed import- 
ant proportions. Of the original members, of 
whom Dr. Sutton was one of the most zealous 
and influential, few survive ; but it is gratifying 
to know that the work which they inaugurated 
has been so nobly pushed forward by their sue- 



DEDICA TOR Y ADDRESS. 



527 



cessors, not a few of whom have achieved a 
wide and enduring reputation as medical phi- 
losophers, clear thinkers, accurate observers, 
and accomplished and sagacious practitioners. 
If any evidence were needed of their zeal to 
advance the interests of medical science and of 
suffering humanity, it would be found, not in 
idle talk or vapid boasting, but in hard work 
and steady and persistent effort, as shown in 
the transactions of their society and in our 
periodical literature. Progress of the most 
laudable character is everywhere visible in its 
ranks. Since the period adverted to most of 
my earlier Kentucky friends in and out of the 
profession have passed away, while of my 
earlier colleagues in the University of Louis- 
ville not one remains. Drake and Caldwell 
and Short and Cobb and Miller and Yandell 
have gone to their last home, to that sleep which 
knows no waking. Palmer and Rogers, who 
entered the school at a later day, have also 
been gathered to their fathers ; the one a bril- 
liant anatomical teacher and a genial and intel- 
ligent companion ; the other for upward of a 
third of a century Louisville's honored, be- 
loved, and favorite physician, with a heart 
gentle as a woman's and a countenance benig- 



528 MEMORIAL SERVICES. 

nant as an angel's. Kentucky has a long list 
of deceased physicians, who have left behind 
them a rich legacy and an example worthy of 
the emulation of their successors, whose duty 
it should be to cherish their memories and to 
transmit to their descendants the history of 
their lives.. 

It would be unjust alike to the occasion, as it 
would be to my own feelings if I failed to con- 
nect with each other and with the great ovari- 
otomist, as with an adamantine chain, the 
names of those of our surgeons, already seve- 
ral times mentioned, who have been instrumen- 
tal in reviving this operation in this country, 
and thus giving it a new impulse. The names 
which stand most conspicuously upon this 
honored list are those of the two brothers 
Atlee, John and Washington, J. Taylor Brad- 
ford, Edmund Randolph Peaslee, Gilman Kim- 
ball, and Alexander Dunlap. Of these six 
pioneers in this field of surgery three have 
passed away, while the other three, John L. 
Atlee, Gilman Kimball, and Alexander Dunlap, 
are still spared to us, in a ripe but vigorous 
old age, to battle with disease and death and to 
earn additional laurels for themselves and their 
country. 



DEDICA TOR Y ADDRESS. 



529 



Of the early life of Dr. J. Taylor Bradford, 
who died a number of years ago in the prime 
and vigor of life, I know nothing, although our 
acquaintance extended over a period of twenty 
years. He received his medical degree from 
the University of Louisville during the early 
part of my connection with that institution, and, 
settling at Augusta immediately afterward, soon 
acquired a large and commanding practice, per- 
forming many important surgical operations, 
and earning an enviable reputation as a most 
successful ovariotomist. Had he reached the 
age usually allotted to man his cases would 
probably have been counted by the hundred. 

Dr. Washington L. Atlee, who died at his 
home in Philadelphia in September, 1878, was, 
as is his brother John, a native of Lancaster, 
Pennsylvania, where he was born in February, 
1808. After having received an academic 
education he graduated at the Jefferson Medi- 
cal College in 1829. Having been fellow- 
students in the office of Professor George Mc- 
Clellan, the eminent surgeon, and having met 
with him very frequently after my removal to 
Philadelphia in 1856, I had excellent opportuni- 
ties of forming a correct estimate of his charac- 
ter, which no one perhaps appreciated more 
34 






C30 MEMORIAL SERVICES. 

fully than myself. If this character was not 
perfect in the true sense of that term it was a 
model worthy of universal imitation. He had 
many striking traits of character, with a strong, 
vigorous mind incased in a strong body, and 
accomplished a vast deal of work. He per- 
formed a much greater number of professional 
journeys than ever fell to the lot of any Ameri- 
can physician. His visits extended into almost 
every State of the Union and even into a num- 
ber of our Territories. His power of endur- 
ance was gigantic. He often travelled thous- 
ands of miles without taking any rest except 
such as he found upon the swiftly-flying railway 
train. Not unfrequently he performed two 
ovariotomy operations on the same day. Such 
labor could not fail to make serious inroads 
upon the stoutest frame, and, although the day 
of reckoning was long put off, it was sure to 
come at length. 

The early professional life of Atlee was spent 
in earnest practice, enlivened by the study of 
botany and other branches of natural science, 
for which he had a great fondness. Much of 
his leisure during the first few years was spent 
among the flowers and grasses of his native 
county. After his removal, in 1844, to Phila- 



DEDICA TOR Y ADDRESS. 



531 



delphia he occupied for eight years the chair 
of chemistry in what was then known as the 
Pennsylvania Medical College. His career as 
an ovariotomist began, as already stated, in 
1844 an d terminated only with his life. His 
first case proved fatal. As an operator in his 
specialty he had no superior on this continent, 
if indeed anywhere. Despising display, always 
so well calculated to entrap the vulgar, he em- 
ployed the fewest possible instruments and 
went about his work calmly and deliberately, 
with the greatest care for the welfare of his 
patient, which, it is safe to say, no man had 
ever more at heart. There was no hurry, no 
parade, no ostentation. I witnessed a number 
of his operations and was strongly impressed 
by the simplicity of his movements and the 
coolness of his manner. Such, in a few words, 
was his character as an operator. But it must 
not be inferred that Dr. Atlee was a mere spe- 
cialist. For many years he enjoyed a large 
and lucrative general practice, although during 
the last quarter of a century of his life his busi- 
ness was mainly in the direction of abdominal 
surgery, in which he achieved an enduring 
reputation. He wrote largely for the medical 
press, and late in life published an able and 



532 MEMORIAL SERVICES. 

elaborate treatise on the Diagnosis of Ovarian 
Tumors, a subject which he invested with new 
light. His operation for the removal of fibroid 
growths of the uterus constitutes a new era in 
surgery, precious alike to science and to hu- 
manity. Like McDowell's operation, Atlee's 
was received with distrust, and remained un- 
appreciated for upward of a quarter of a cen- 
tury. Time, however, which generally meas- 
ures things according to their real value, has 
made a strong verdict in its favor, and it is 
therefore not surprising that the gynecologists 
of America and Europe should unite in pro- 
claiming it as one of the greatest achievements 
of modern surgery. Atlee's own successes 
should have been quite sufficient to convince 
any unprejudiced mind of its great value. 

Atlee had a strong but tender, sympathizing 
heart, a well-regulated temper, a high sense of 
honor, and a clear and well-cultivated mind. 
Tall and erect in person, he had a commanding 
presence, blended with the air and graces of 
the well-bred gentleman. In the sick-room he 
was cheerful and winning in his manners, with 
a heart full of kindly feeling for the sufferer. 
He was the idol of his family, a warm friend, a 
loyal citizen, a consistent Christian. His last 



DEDICA TOR Y ADDRESS. 



533 



illness, extending over a period of three months, 
was cruelly severe, but he bore his suffering, 
which was daily making sad inroads upon his 
previously robust frame, without a murmur of 
complaint or impatience. The gradual decay 
of his body did not impair his intellectual 
powers, and his mind remained clear to the 
last. No man, perhaps, ever set his house 
more perfectly in order than he did ; not even 
the most minute details were overlooked. Im- 
partial history will assign to Washington L. 
Atlee a high rank in the temple of fame as an 
original thinker, an accomplished surgeon and 
physician, and a benefactor of his race. 

Dr. Edmund Randolph Peaslee, whose name, 
as has been stated, is, like that of Atlee, so 
honorably associated with the progress of 
ovariotomy in this country, died in January, 
1878, only about eight months before his dis- 
tinguished Philadelphia confrere. Born in New 
Hampshire in 18 14, he was emphatically a 
many-sided man, of high culture, great refine- 
ment, vast industry, and extraordinary pro- 
fessional resources in cases of emergency. 
With the exception of Nathan Smith, of New 
Haven, a contemporary of McDowell, I have 
no recollection of any man who in recent times 



534 MEMORIAL SERVICES. 

lectured on so many branches of medical sci- 
ence or filled chairs in so many medical schools. 
Anatomy and physiology, general pathology, 
surgery, obstetrics, and gynecology were the 
diversified themes which from time to time 
engaged his facile brain as a public teacher. 
He was also an expert and cautious operator 
and a most accomplished physician, especially 
distinguished for his skill as a diagnostician. 
Besides numerous papers contributed to the 
periodical press, he was the author of several 
books ; among others an exhaustive treatise on 
Ovarian Tumors, published in 1872, a pro- 
duction which, while it greatly enhanced his 
reputation at home, made his name widely 
known abroad. Of his operations I have 
already spoken. The private character of Dr. 
Peaslee may be best summed up in the beau- 
tiful words of his biographer, the Rev. Dr. 
Bartlett, President of Dartmouth College, who, 
having known him long and well, thus speaks 
of him: " His day," says this accomplished 
scholar, "is done; his sun is set. But from 
the scene of its setting there streams up a trail- 
ing brightness, as of some perpetual zodiacal 
light — the shining example of one who, while 
profound in science, wise in counsel, and ex- 



DEDICA TOR Y ADDRESS. 



535 



cellent in skill, was also sincere in piety, blame- 
less in manhood, true in friendship, genial in 
intercourse, and whose presence enters the 
sick-chamber like a sunbeam from heaven 
streaming into a darkened room. Its mild 
radiance lingers in hundreds of homes and 
thousands of hearts. It is a life profitable for 
young men to contemplate." 

Young men of the Kentucky State Medical 
Society, listen to the voice of one who has 
grown old in his profession, and who will prob- 
ably never address you again, as he utters a 
parting word of advice. The great question of 
the day is, not this operation or that, not ovari- 
otomy or lithotomy, or a hip-joint amputation, 
which have reflected so much glory on Ken- 
tucky medicine ; but it is preventive medicine, 
the hygiene of our persons, our dwellings, our 
streets ; in a word, our surroundings, whatever, 
and wherever they may be, whether in city, 
town, hamlet, or country, and the establishment 
of efficient town and State boards of health, 
through whose agency we shall be the better 
able to prevent the origin and fatal effects of 
what are known as the zymotic diseases, which 
carry so much woe and sorrow into our families, 
and which often sweep, like a hurricane, over 



t^6 MEMORIAL SERVICES. 

the earth, destroying millions of human lives in 
an incredibly short time. The day has arrived 
when the people must be roused to a deeper 
and more earnest sense of the people's welfare, 
and when suitable measures must be adopted 
for their protection as well as for the better 
development of their physical, moral, and intel- 
lectual powers. This is the great problem of 
the day, the question which you, as representa- 
tives of the rising generation of physicians, 
should urge, in season and out of season, on 
the attention of your fellow-citizens ; the ques- 
tion which, above all and beyond all others, 
should engage your most serious thoughts and 
elicit your most earnest cooperation. When 
this great, this mighty object shall be attained ; 
when man shall be able to prevent disease and 
to reach with little or no suffering ' his three- 
score years and ten, so graphically described 
by the Psalmist, then, but not till then, will the 
world be a paradise, with God, Almighty, All- 
wise, and All-merciful, in its midst, reflecting 
the glory of His majesty and power, and hold- 
ing sweet converse in a thousand tongues with 
the human family. 



ADDRESS OF PROFESSOR SAYRE. 



No word from me can add a single laurel to 
the crown of the immortal McDowell, whose 
history and services to mankind have been so 
beautifully and truthfully portrayed by the dis- 
tinguished orator of the evening, the Nestor of 
American surgery, Prof. Gross. In fact, any 
remarks from me in my individual capacity 
would seem almost inappropriate, but in my 
official capacity as President of the American 
Medical Association it is my duty as well as my 
pleasure to bring to the monumental shrine the 
ovations of the entire medical profession of 
these United States. And, Sir, I venture here 
the prediction that in all time to come the 
intelligent surgeons, either in person or in 
thought, from every part of the civilized globe, 
will wander here to Danville to pay their 
respects and sense of obligation to the memory 
of Ephraim McDowell, who has contributed 
more to the alleviation of human suffering and 
the prolongation of human life than any other 

(537) 






cog MEMORIAL SERVICES. 

member of the medical profession in the nine- 
teenth century. We can scarcely comprehend 
the greatness of this man's mind, and the truly 
wonderful genius of McDowell, until we stop 
to consider who he was, what he did, and when 
and where he did it. A village doctor in the 
backwoods frontier, surrounded by Indians and 
the buffalo, almost beyond the bounds of civili- 
zation, with no books to refer to, with no pre- 
cedent to guide, with no one to consult but his 
own unaided judgment, with no one to share 
the responsibility if unsuccessful, unaided and 
alone assumes the responsibility of removing 
a disease which up to that time had been con- 
sidered absolutely incurable. Think for a mo- 
ment what would have been the result of failure 
— a coroner's jury, and a verdict of wilful mur- 
der, which at that time would have been pro- 
nounced correct by the entire medical profes- 
sion throughout the civilized globe. All this 
he dared and did assume, because his clear 
intellect had reasoned out his plan of proce- 
dure, and his careful dissections had pointed 
out to him the path to victory. And now every 
intelligent surgeon in the world is performing 
the operation as occasion requires, until at the 
present time, as Dr. Thomas has stated, forty 



ADDRESS OF PROFESSOR SAYRE. 



539 



thousand years have already been added to the 
sum of human life by this one discovery of 
Ephraim McDowell. 

Another fact strikes me very forcibly, Mr. 
President, and that is, the heroic character of 
the woman who permitted this experimental 
operation to be performed upon her. The 
women of Kentucky in that period of her early 
history were heroic and courageous, accus- 
tomed to brave the dangers of the tomahawk 
and scalping-knife, and had more self-reliance 
and true heroism than is generally found in the 
more refined society of city life ; and hence the 
courage of Mrs. Crawford, who, conscious that 
death was inevitable from the disease with 
which she suffered, so soon as this village doc- 
tor explained to her his plan of affording her 
relief, and convinced her judgment that it was 
feasible, immediately replied, " Doctor, I am 
ready for the operation ; please proceed at 
once and perform it." 

All honor to Mrs. Crawford ! Let her name 
and that of Ephraim McDowell pass down in 
history together as the founders of ovariotomy. 

Kentucky has many things to boast of in 
climate, soil, and magnificent forests of oak 
carpeted with her native bluegrass, far surpass- 






540 MEMORIAL SERVICES. 

ing in beauty and grandeur the most elegantly 
cultivated parks of England. She is famed for 
her beautiful and accomplished women ; she is 
renowned for her statesmen, her orators, and 
her jurists ; her Clays, her Johnsons, her Wick- 
liffes, her Crittendens, her Marshalls, her 
Shelbys, her Prestons, her Breckinridges, and a 
host of others ; but no name will add more to 
the lustre of her fame than the one whose 
name we this day commemorate by erecting 
this monument to Ephraim McDowell, the 
ovariotomist. 



CORRESPONDENCE. 

LETTERS FROM DISTINGUISHED GENTLEMEN AND 
MEMBERS OF THE PROFESSION. 



L. S. McMurtry, M.D., 



Chairman McDowell Monument Committee. 



My dear Doctor : With eagerness I ac- 
cepted, a few weeks since, the invitation of your 
committee, and anticipated rare pleasure in 
meeting the many distinguished medical gentle- 
men whom the occasion and the exercises so 
wisely planned for the dedication of the monu- 
ment just erected at Danville to the memory 
of Ephraim McDowell would naturally bring 
together. 

The medical profession of the United States, 
under the auspices of the Kentucky State 
Medical Society, has honored itself in honoring, 
by this special mark of gratitude, Kentucky's 
most eminent surgeon. 

The purpose of the meeting — a public and 
emphatic indorsement by the profession of the 
country — affirming the claim of originality in the 
operation of ovariotomy to Dr. McDowell, and 

(54i) 



542 MEMORIAL SERVICES. 

showing a readiness to recognize and admire 
superior genius in our ranks, and hold it up for 
imitation and encouragement, will certainly 
meet the approbation of every lover of the 
science of medicine. 

For a number of years I enjoyed the rare 
privilege of an intimate friendship with Dr. 
John D. Jackson, of Danville, the originator of 
the project to have the medical profession of 
America erect a becoming monument to Ken- 
tucky's — yes, to America's great surgeon, Dr. 
Ephraim McDowell, of Danville, Kentucky, 
who had the genius to devise and the courage 
to execute, almost without assistance, the for- 
midable operation of ovariotomy in your town. 
Well do I remember the enthusiasm of Dr. 
Jackson when commenting upon this splendid 
operation, which has added greater security to 
the life of woman, rendered its originator's 
name imperishable, elevated the character of 
medicine everywhere, and given fame to Ame- 
rican surgery throughout the civilized world. 

Ovariotomy deserves to rank as one of the 
four greatest discoveries in the progess of 
medical science, along with the circulation of 
the blood, vaccination, and anaesthetics. 

Besides my enforced absence I have but one 



CORRESPOXDENCE. 



543 



regret, which I doubt not is felt by all who may 
be present with you, which is that Dr. Jackson 
was not spared to take part in the dedication of 
this noble and appropriate memento to his 
townsman, to whose memory and achievements 
he was so ardently attached. 

The work in its consummation will, I am con- 
fident, as faithfully and imperishably perpetuate 
the fame of Jackson as it does the name of the 
noble McDowell, for whom it has been erected. 

Thanking you, gentlemen, for your courtesy, 
and regretting more than I can express my 
inability to be present to testify by my presence 
my appreciation of your commendable and so 
satisfactorily completed labors, and to have the 
pleasure of hearing the dedicatory address of 
the veteran American surgeon, Prof. S. D. 
Gross, as well as to meet old friends and par- 
take of your hospitality on this occasion, 

I am, with sentiments of regard, 
Very truly yours, 

J. M. Toner, M.D. 



Washington, May 13, 1879. 



544 MEMORIAL SERVICES. 

L. S. McMurtry, M.D, 

Chairman McDowell Monument Committee. 

Dear Doctor : I have much pleasure in 
acknowledging receipt of the invitation to 
attend the memorial occasion in honor of "the 
Father of Ovariotomy." Unfortunately for me 
some professional duties here, which cannot in 
any way be postponed, will compel my return 
home from Atlanta immediately after the ad- 
journment of the American Medical Associa- 
tion. 

It is well in the name of American surgery, 
and in the name of a common philanthropy, 
that this honor, though tardy, should be paid 
to the memory and fame of Ephraim McDowell. 

I cannot but think of the fact that the erec- 
tion of the monument is largely due to the 
original suggestion and active efforts of one 
who recently passed away from earth before 
he had reached the noon of his power and repu- 
tation, one who was esteemed and admired by 
every physician North, South, East, and West. 
The monument will tell not only of " the Father 
of Ovariotomy," but also of John D. Jackson. 
I am, dear Sir, yours very truly, 

Theopi-iilus Parvin. 

Indianapolis, Ind., May i, 1879. 



CORRESPONDENCE. 



545 



L. S. McMlJRTRY, M.D., AND OTHERS, 
Of the McDowell Monument Committee. 

Gentlemen : Your kind invitation to attend 
the dedication of the McDowell monument is 
just received, for which I beg leave to return my 
thanks, and the assurance of my sincere regret 
that I shall be prevented from taking part in 
the interesting ceremonies. 

The occasion is one of extraordinary import, 
in that it is the first and only instance in the 
history of the United States that such honors 
have been paid to the memory of a physician ; 
and secondly, that the virtues which it is pro- 
posed to perpetuate in the monument were 
consecrated to the saving of human life and the 
mitigation of human suffering. Of the man 
Ephraim McDowell we know T comparatively 
little, but of the great original ovariotomist no 
one at all concerned in the progress of surgery 
can be ignorant. As a Kentuckian no less 
than as a surgeon I have always felt the deepest 
interest in his history, and have sought in his 
life and surroundings to penetrate to the origin 
of the great thought, and still greater courage, 
that gave expression to the thought which, 
without the sanction of precedent, and unaided 
by the advice or sympathy of others, culminated 

35 



r^5 MEMORIAL SERVICES. 

in the institution of an operation by which 
thousands of women heretofore doomed to 
early death now live to bless his name. 

But who can discover and open the secret 
door which hides from profane view the sacred 
laboratory of genius ? Or who can trace the 
footsteps of the inspired discoverer as he works 
his narrow way out to the confines of human 
experience, and with purged eye looks into the 
mysteries which lie beyond ? All that we can 
do is to cheer on with our words of encourage- 
ment, and, when the work is done, with willing 
hands distribute its benefits to those who are in 
need, never forgetting to pronounce a blessing 
upon the author. In this spirit of humble 
reverence I bow my bared head before him 
whom you this day exalt in the sight of the 
whole world as one of its greatest benefactors, 
and proclaim by your act that the highest and 
noblest ambition of the physician should be 
the saving of human life. Who is there, since 
the days of Jenner, who can in this respect 
compare with the " backwoods surgeon of Ken- 
tucky? " I would not derogate in the slightest 
degree from the deserved honor which belongs 
to many who have followed their profession 
with equal zeal and earnestness, and who have 



CORRESPONDENCE. 



A7 



added largely to the resources of the healing 
art, but in the inscrutable wisdom of the Creator 
of all things it has not been given to any other 
single laborer in the field of medicine and sur- 
gery upon this western hemisphere to confer so 
great a blessing upon the human race. 

All honor to the memory of Ephraim Mc- 
Dowell, the man of genius, the wise and heroic 
surgeon, the benefactor of his kind. When 
the granite shaft which you have erected to 
signalize what he was and what he did shall 
have fallen into decay, his name will still be 
perpetuated by the many lives saved through 
his instrumentality. 

I am, gentlemen, with great esteem, your 
obedient servant, 

T. G. Richardson, 

New Orleans, May 9, 1879. 



L. S. McMurtry, M.D., 

Chairman McDowell Monument Committee. 

Dear Sir : I thank you very much for your 
invitation to attend the meeting connected with 
the McDowell monument, and I deeply regret 
that I am unable to leave London at present. 

It would give me extreme pleasure to be 
present at so interesting a ceremony, to make 



548 MEMORIAL SERVICES. 

the acquaintance of so many of my American 
professional brethren, and to show my respect 
to the memory of " the Father of Ovariotomy." 
I shall hope in some future year to visit your 
great country again, and to see the monument 
you have raised over the grave of McDowell. 
Very sincerely, 

T. Spencer Wells. 

3 Upper Grosvenor Street, London W., April 24, 1879. 

L. S. McMurtry, M.D., 

Chairman McDowell Monument Committee. 

Dear Sir: I regret that it is not in my power 
to renew the pleasure of a former visit to Ken- 
tucky and take part in the exercises at the 
dedication of the McDowell monument, at 
least so far as to be a sympathetic listener to 
all the eloquence which the occasion will call 
forth. 

I feel a personal interest in the surgical con- 
quest which is to be commemorated in addition 
to that which all the world recognizes. Among 
the births of the century this is a twin with my- 
self. Dr. McDowell's first operation dates from 
the same year as that in which I first inhaled 
the slow poison that envelops our planet, the 
effects of which I have so lone survived. I 



COKRESP ONDENCE. 



549 



thank God that the other twin will long outlive 
me and my memory, carrying the light of life 
into the shadows of impending doom, the 
message of hope into the dark realm of de- 
spair ; opening the prison to them that are 
bound and giving them beauty for ashes, the 
beauty of a new-born existence even, it may 
be, as I have but recently seen it, of youthful 
and happy maternity in place of the ashes for 
which the inevitable urn seemed already wait- 



I am glad that this great achievement is to 
be thus publicly claimed for American surgery. 
Our trans-Atlantic cousins have a microphone 
which enables them to hear the lightest foot- 
steps of their own discoverers and inventors, 
but they need a telephone with an ear-trumpet 
at their end of it to make them hear anything 
of that sort from our side of the water. There 
is another kind of trumpet they do not always 
find themselves unprovided with, as those who 
remember Sir James Simpson's astonishing 
article, " Chloroform," in the eighth edition of 
the Encyclopedia Britannica, decently omitted 
and ignored in the ninth edition of the same 
work, do not need to be reminded. 

If there was any one who could dispute Dr. 



55<D MEMORIAL SERVICES. 

McDowell's claim to be called " the Father of 
Ovariotomy" it would have been our own Dr. 
Nathan Smith — our own and your own too, for 
he also was born and lived and died on the 
sunset side of the Atlantic, and within the 
starry circle which holds us all. Dr. Smith 
performed the operation of ovariotomy with 
success early in the century, but unfortunately 
there is no record, so far as I know, of the 
exact date. I allude to this fact not to invali- 
date Dr. McDowell's claim, for an undated case 
cannot do it, but to couple with his name as at 
least next in priority that of another native 
American practitioner worthy of companionship 
with the greatest and the best. 

A single thought occurs to me which may 
help to give this occasion something more than 
professional significance. Although our politi- 
cal independence of the mother country has 
been long achieved, our scientific and literary 
independence has been of much slower growth. 

And as we read the inscription on this monu- 
ment, let us gratefully remember that every 
bold, forward stride like this grand triumph of 
American science, skill, and moral courage, 
tends to bring us out of the present period of 
tutelage and imitation into that brotherhood 



CORRESPONDENCE. 



551 



and self-reliance which should belong to a 
people no longer a colony or a province, but a 
mighty nation. I am, dear sir, 

Yours very truly, 
Oliver Wendell Holmes. 

Boston, May 9, 1879. 



L. S. McMurtry, M.D., 

Chairman McDowell Monument Committee. 

My dear Sir : It is with extreme regret that 
I find myself prevented from accepting your 
kind invitation to take part in the dedication of 
the monument to the " Father of Ovariotomy." 
Although absent in body let me assure you 
that I shall be present in spirit. 

Kentucky cherishes the memory of many 
noble sons, but nowhere in her annals can she 
point to a name more deserving of her pride 
than that which adorns the monument erected 
to commemorate McDowell's glory. 

Others have given her the proud records of 
the warrior, the statesman, , the philosopher, 
and the philanthropist. McDowell, favored by 
God above other men, has already bestowed 
upon humanity more than forty thousand years 
of active life, and insured for the future results 
which will surely dwarf those of the past. 



552 MEMORIAL SERVICES. 

The noble tribute which you erect in his 
honor will last long, but it will crumble into 
dust and be scattered abroad by the winds, 
while his memory will continue to live green 
and vigorous in the hearts of a grateful pos- 
terity. 

With sentiments of sincere regard, 
I am, dear sir, 

Very truly yours, 

T. Gaillard Thomas. 

294 Fifth Avenue, N. Y., May 1, 1S79. 



PRESENTATION ADDRESS. 



Remarks made by Prof. Richard O. Cowling, M.D., 
of Louisville, in Presenting the Door-knocker 
of Dr. McDowell's House to Dr. Gross. 



Dr. Gross, the Kentucky State Medical 
Society thanks you for the beautiful oration 
you have just delivered on Ephraim McDowell. 
Surely hereafter, when history shall recall his 
deeds and dwell upon his memory, it will relate 
how, when he was fifty years at rest, the great- 
est of living surgeons in America came upon a 
pilgrimage of a thousand miles to pronounce 
at his shrine the noble words you have spoken. 

The Society does not wish that you should 
return to your home without some memento of 
the occasion which brought you here, and which 
shall tell you also of the admiration, the respect, 
and the affection it ever bears for you. 

I have been appointed to deliver to you this 
simple gift, with the trust and the belief that it 
will always pleasantly recall this time and be a 

( 553) 



r^4 MEMORIAL SERVICES. 

token of our feelings toward you. We wished 
to give you something directly connected with 
McDowell, and it occurred to us that this me- 
mento of the dead surgeon would be most 
appropriate. It is only the knocker which hung 
upon his door, but it carries much meaning 
with it. 

The sweetest memories of our lives are 
woven about our domestic emblems. The 
hearthstone around which we have gathered, 
the chair in which our loved ones have sat, the 
cup their lips have kissed, the lute their hands 
have swept — what jewels can replace their 
value ? Do you remember the enchantment 
that Douglas Jerrold wove about a hat-peg? 
How at the christening of the child they gave 
it great gifts of diamonds and pearls and laces ; 
and when the fairy godmother came, and they 
expected that she would eclipse them all with 
the magnificence of her dowry, how she gave it 
simply a hat-peg ? They wondered what good 
could come of that. The boy grew to be a 
man. In wild pursuits his riches were wasted, 
and at last he came home and hung his hat 
upon that peg. And while the goodman's hat 
was hanging there peace and plenty and order 
and affection sprang up in his home, and the 
hat-peg was indeed the talisman of his life. 



PEESEXTA TION ADDRESS. 



555 



I would that the magician's wand were 
granted me a while to weave a fitting legend 
around this door-knocker, which comes from 
McDowell to you, Dr. Gross. There is much 
in the emblem. No one knows better than 
you how good and how great was the man of 
whom it speaks. It will tell of many a summons 
upon mercy's mission which did not sound in 
vain. Ofttimes has it roused to action one 
whose deeds have filled the world with fame. 
A sentinel, it stood at the doorway of a happy 
and an honorable home, whose master, as he had 
bravely answered its signals to duty here below, 
so when the greater summons came, as trust- 
fully answered that, and laid down a stainless 
life. 

It belongs by right to you, Dr. Gross. This 
household genius passes most fittingly from the 
dearest of Kentucky's dead surgeons to the 
most beloved of her living sons in medicine. 
She will ever claim you as her son, and will 
look with jealous eye upon those who would 
wean you from her dear affection. 

And as this emblem which now is given to 
you hangs no longer in a Kentucky doorway, 
by this token you shall know that all Kentucky 
doorways are open at your approach. By the 



— 6 MEMORIAL SERVICES. 

relief your skill has wrought ; by the chiefs 
your great heart has healed ; by the sunshine 
you have thrown across her threshold ; by the 
honor your fame has brought her ; by the 
fountains of your wisdom at which your loving- 
children within her borders have drunk, the 
people of Kentucky shall ever open to you 
their hearts and homes. 



DR. GROSS'S REPLY. 



I am much overcome, gentlemen of the Ken- 
tucky State Medical Society, by this mark of 
your approbation. I am not the great man 
your speaker has declared me to be, but I 
gratefully appreciate the feelingb that have 
prompted his words. I claim to be but an 
earnest follower of Surgery, who during a 
period which has now extended beyond half a 
century, has striven to the best of his ability to 
grasp its truths and to extend the beneficence 
of its offices. I am not to be placed by the side 
of McDowell, for what I may have done in our 
art ; but if this reward be a measure of the 
appreciation I hold of the good-will of the 
people in. this Commonwealth, I may claim it 
for that. 

The years of my life which I passed in Ken- 
tucky represent the most important era in my 
career. They witnessed many of its struggles 
and much of the fruition of its hopes. To the 

warm hearts of the many friends it was my 

(557) 



3 

' 3 6X17 

MEMORIAL SERVICES. 



558 

good fortune to secure within these borders do 
I owe it that those struggles were cheered and 
rewards beyond my deserts were secured. 

I take this emblem now offered me as the 
most valued gift of my life. It shall be received 
into my home as a household god, environed by 
all the memories of goodness and greatness to 
which your speaker has referred, and above all 
recalling this scene. Dying I shall bequeath 
it, among my most important possessions, to 
the family that I may leave, or in failure of that, 
to be preserved in the archives of some society. 

I thank you again, gentlemen, and I wish I 
were able to tell you better how much I thank 
you. 



ufi 



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